Implantation of permanent pacemaker leads into the cephalic vein within the deltopectoral groove is enhanced by introduction of a flexible guidewire into the brachial vein at the antecubital fossa, which is then advanced to the subclavian vein. The cephalic vein within the deltopectoral groove is easily found by incision with the guidewire as a marker. A pacing lead or leads can be inserted along the guidewire or by using a sheath advanced over the guidewire. The procedure was performed on 32 patients and the pacing leads of 28 procedures (DDD 15, VDD 9 and WI 4) were inserted using the cephalic vein without complications.