Introduction
The cardiac resynchronisation therapy–defibrillator (CRT-D) is an established treatment for heart failure which reduces morbidity and mortality (1). The pacing leads are predominantly implanted via the transvenous approach, usually by subclavian or axillary puncture and sometimes by cephalic vein cut-down. There is no standard approach, but cephalic access is feasible, effective and safe (2)(3), irrespective of the number of leads being implanted (4). Traditional lateral subclavian vein puncture has been associated with a higher rate of lead failure than the use of cephalic venous access (5)(6), but a recent report has suggested that multi-lead defibrillator therapy utilising the cephalic route is associated with early implantable cardioverter defibrillator (ICD) lead failure (7).