**6.2 Surgical incision**

To get better anatomical access to the central vessels of the heart, we use local anesthesia with the administration of 4.5 mg/kg of 2% lidocaine for the sake of the patient's comfort. Then, an incision is made (2.5 inches for PPM and 3.5–4 inches for ICD) with a number 15 blade in the distal third of the right infraclavicular region of the anterior chest wall (**Figure 3**). The subcutaneous tissue is opened and dissected in a layer under the pectoralis major fascia with accurate homeostasis using electrocautery (**Figure 4**). The development of a subpectoral pocket may be advisable in patients with a low body-mass index and for esthetic reasons.
