Permanent pacemaker implantation can be done in the cardiac catheterization laboratory or in the operating room. Both locations have unique advantages and disadvantages. The operating room often has better lighting and thus allows better visualization of the device pocket, but fluoroscopy can be less optimal in the operating room, which generally utilizes a C-arm radiology device. Sterility was once thought to be more advantageous than the operating room setting. Data support that infection rates tend to be extremely low in both settings. Scrub technicians and assistants in the operating room are often equally matched by personnel in busy cardiac catheterization | Leads available for temporary pacing include the standard bipolar temporary transvenous lead, which can be manipulated easily across the tricuspid valve and into the right ventricle. A balloon-tipped electrode does allow fairly easy passage across the tricuspid valve, aided by blood flow. The balloon is deflated once it crosses the tricuspid valve, and then placed into the endocardium. This lead tends to be more flimsy and less maneuverable with torque. The risk of perforation may be lower. A third approach is to deliver an active fixation temporary pacemaker lead via a catheter-delivered technique. This very small lead has the advantage of being more stable than typical temporary leads and may be an advantage when leads have to be placed long term. This small 2 French system has an active coil in the end which can be rotated into the ventricular or atrial endocardium, as needed. This technique would be helpful in a patient who needs temporary pacing for several days rather than just for a few hours. The technique of this lead delivery through a catheter system is important
