The Implant Procedure

Transvenous leads are threaded through the venous system to place the electrodes in the heart chamber. This is accomplished either by a venotomy (usually in the cephalic vein) or a subclavian "stick" using a percutaneous introducer.72 Once the lead tip is in the vein, it is advanced to place the distal tip either in the right ventricle or right atrium. For dual-chamber pacemakers, both an atrial and ventricular lead are placed. After the lead is positioned and tested, it is fixed at the venous insertion site or to the muscle with a suture, with or without an anchoring sleeve, as will be discussed later. The lead terminal(s) are inserted into the pulse-generator connector and are secured with set screws. Then the excess lead is coiled around the pulse generator, which is placed in a subcutaneous or intermuscular pocket.

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