Comment on “Outcomes of Supraclavicular Access in Temporary Pacemaker Implantation”

We read with great interest the article by Ben Yezza et al. entitled Outcomes of Supraclavicular Access in Temporary Pacemaker Implantation (Yezza et al. 2026). The authors should be commended for addressing an important yet relatively underexplored venous access route in urgent pacing scenarios. The study highlights the feasibility and high procedural success of the supraclavicular approach, with a reportedly low complication profile. Given the ongoing search for safer and faster vascular access in critically ill patients requiring temporary pacing, these findings are clinically relevant and timely. The straight anatomical course to the brachiocephalic vein and the potential for improved lead stability are particularly noteworthy advantages emphasized by the authors. However, several methodological points merit clarifications. First, the study design defines the infraclavicular group as patients who underwent femoral venous access. In this context, the reported higher pneumothorax rate in the infraclavicular group appears unexpected, given that pneumothorax is exceedingly rare with femoral cannulation. Clarification of the exact access routes included in each group and the attribution of access-related complications would help readers interpret these findings more accurately. Second, the authors state that both supraclavicular and femoral procedures were performed by the same cardiology team and that operator experience was accounted for in the statistical analysis to minimize variability. However, the presentation of operator experience within the baseline characteristics table raises questions regarding how this variable was modeled and adjusted for in the comparative analysis. Providing additional details on whether operator experience was treated as a covariate, stratification factor, or matching variable would strengthen confidence in the internal validity of the results. An additional anatomical consideration that warrants discussion is the presence of persistent superior vena cava, particularly persistent left superior vena cava (PLSVC) (Hassine et al. 2015). The manuscript notes that procedures were performed via right-sided access, which may have mitigated some of the technical challenges associated with venous anomalies. However, in clinical practice—especially when left supraclavicular access is used—PLSVC can substantially alter lead trajectory via the coronary sinus and increase procedural complexity. Explicit discussion of how the findings might translate to left-sided supraclavicular approaches would further enhance the generalizability and practical relevance of the study. Despite these limitations, the authors provide valuable data supporting supraclavicular venous access as a viable alternative for temporary pacing. We congratulate the authors on their contribution and look forward to further comparative studies that will help better define the role of this approach in contemporary practice. E.Ç.B., E.B., and B.G. drafted the letter. E.Ç.B. and E.B. critically revised the content. All authors approved the final version. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.