(a) Placement of a Ventricular Pacing Lead from the Superior Vena Cava (Via the Internal Jugular or Subclavian Veins)

(a) The lead is advanced to the low right atrium. (b) Further advancement produces a loop or bend in the distal lead, which is then rotated medially. (c) Alternatively, the lead in low right atrium deflects off the tricuspid annulus directly into the right ventricle. (d) Superior orientation of the lead tip in the ventricle requires clockwise torque during advancement to avoid the interventricular septum. (e) Final lead position in the right ventricular apex. The catheter position in (b) is suitable for atrial pacing.