**7.6 Sixth stage. Atrial lead implantation and pacemaker placement**

Implantation of the atrial lead is conventionally performed in the right atrial appendage or the interatrial septum (**Figure 8**). Atrial and ventricular sensing should be no less than 0.45 mV.

**Figure 8.** *Final lead and pacemaker positioning in HBP. Red arrow points at the HB pacing lead (AP LL view).*

#### **Figure 9.**

*Detection of the pacing threshold for HB. Asynchronous bipolar stimulation at 90 bpm. The first arrow marks the last QRS complex conducted through HB – Pacing threshold for HB. QRS width is 89 ms. the next QRS complex is a deformed one; its width is 167 ms – Pacing threshold for RV myocardium (second arrow). The third arrow points non-response spike.*

In the presence of an initially high pacing threshold for HB, it is recommended to consider pacemakers with prolonged longevity.
