559 permanent pacemaker implantations were accomplished between October 1, 1974, and September 30, 1979: 542 through the right subclavian vein, 10 through the left subclavian vein and 7 through the jugular veins. We prefer to make the incision first, then inserting the needle through the opened wound under fluoroscopic control. Pneumothorax was noted in 5 cases = 0.9 percent, only 2 patients required chest tubes, there were no permanent sequelae. Dislocation of the electrodes occurred in 6.6 percent, in the last 12 months only in 4.7 percent, using primarily leads with shoulder tip. This method is contraindicated in patients with chronic emphysema with bronchial obstruction, retrosternal struma or subclavian thrombosis. We have found that this technique, carefully applied, affords a rapid, safe, relatively atraumatic method of permanent transvenous electrode placement.