An implantation of DDD epicardial pacemaker through ministernotomy in a patient with a superior vena cava occlusion.

We successfully implanted a DDD epicardial pacemaker through a limited lower sternotomy in a patient whose superior vena cava had been occluded. Both epicardial leads were connected to the generator placed in the existing subcutaneous pocket on the left pectoral region through the second intercostal space. This approach provided excellent exposure and easy access to both the right appendage and the right ventricle. The combined procedure of epicardial DDD pacemaker implantation through a limited lower sternotomy with placement of the generator in the pectoral subcutaneous pocket is one of the better methods when intravenous lead implantation is difficult.