Contralateral transvenous left ventricular lead placement of an implantable device with pre‐sternal tunneling in an ipsilateral chronically obstructed subclavian vein

Multiple methods are used to tackle ipsilateral obstructed venous access in patients undergoing a device upgrade by implanting a new left ventricular lead. One feasible solution to tackle this is implantation of the upgrade lead contralaterally with pre-sternal tunnelization to the opposite side under conscious sedation.