Transatrial dual chamber biventricular pacemaker-defibrillator placement in a patient with SVC obstruction.

A patient with severe congestive heart failure and obstruction of the superior vena cava required biventricular pacing and ICD therapy. Via right minithoracotomy, a transatrial approach for lead placement was successfully utilized to provide cardiac resynchronization and ICD placement. This technique for pacing lead placement is reviewed and its application for biventricular pacemaker-defibrillator placement is reported.