Two hundred sixty-eight dual-chamber pacemaker implants using polyurethane leads for atrium and ventricle were analyzed for the vein of entry for both atrial and ventricular leads. The cephalic vein was used for both leads in 61.2%, the external jugular vein for both leads in 8.6%, both veins in 7.8%, and the subclavian vein alone in 16.4%. The total for venous cutdown alone was 77.6%. There were no complications relevant to the vein of approach for the venous cutdown leads, but there was one pneumothorax requiring thoracic intubation for the subclavian puncture route. Venous cutdown is satisfactory for dual-chamber pacing requiring two lead systems.