**7. Analysis**

#### **7.1 Initial analysis**

Pre-activation lead analyses have revealed the proper lead location and features as follows:


After initial analysis and making sure about proper leads position, the ventricular and atrial leads are screwed (activated), fixed, and re-analyzed. The same steps are carried out for RV lead-coiled (58 or 65 cm length) and should be more cautious of which can cause more endocardial trauma to the heart structures because of more stiffness. The ST-segment elevation (STE) diagram is checked in pace maker programmer. After screwing, the suture sleeve of the lead should be tied with a 3-0 black silk suture to pectoralis major fascia. Thus, each lead is fixed in two areas, the endocardium (screwed) and on the pectoralis major muscle. In the next step, after changing the surgical gloves and irrigating the subcutaneous pocket with a normal saline solution ensuring strict observance of sterility, the outer end of the RV and RA leads is connected to the pulse generator and securely screwed. The pulse generator is then placed in the subcutaneous pocket, so that the outer end of the leads is rounded beneath the generator with no bending and kinking. The PPM and the ICD function should be programmed using a sterile head or wireless programmer. The wound is

repaired in three layers following irrigation and homeostasis. The patient is then transferred to the recovery room for further vital signs monitoring. A sandbag weighing 1–3 kg can be placed on the wound site to prevent hematoma, and finally admitted to the OHICU. On the same day, chest X-ray and ECG tests are performed. Prior to discharge, we should make sure about wound healing and proper functioning of device (final analysis) and patient's general conditions to be satisfactory and provide the patient with all required information about new lifestyle and device dependency, accordingly those patients with ICD should be trained and aware of the painfulness of related shock. Scheduling for further visits and analyses is recommended.
