Implantação de pacemaker definitivo dupla câmara por via femoral

We read with great interest the article by Rodrigues et al., entitled ‘‘Permanent pacemaker implantation using a femoral approach’’, published in the Journal in November 2014, which described two cases of single-chamber permanent pacemaker (PPM) implantation, in VVI mode, by a femoral approach. In the second case, the device was implanted due to symptomatic bradycardia, with intermittent periods of Mobitz II and complete atrioventricular block (AVB), with preserved sinus rhythm. We also note the article by Valente et al., entitled ‘‘Femoral approach: an exceptional alternative for permanent pacemaker implantation’’ published in the Journal in May 2014, which reported a case of single-chamber PPM implantation, in VVIR mode, by a femoral approach, in a patient with symptomatic 2:1 AVB, with preserved sinus rhythm. Most operators are unfamiliar with this technique, although it has been known since the 1980s. Against this background, we would like to share one of our cases and to comment on the type of device implanted. An 86-year-old man, with chronic kidney disease and under regular hemodialysis via a left brachiocephalic arteriovenous fistula, had previously had a PPM implanted in right pectoral position for symptomatic intermittent 2:1 AVB; the device was subsequently removed due to infection. A dual-chamber PPM was then implanted via a right femoral