Where should the leads of a transvenous pacemaker or AICD be located?
A right atrial lead (usually in the right atrial appendage) curves around the right side of the heart just below the SVC on a frontal chest radiograph. A right ventricular lead should project slightly to the left of midline, overlapping the ventricular apex on a frontal chest radiograph, and should project anteriorly and inferiorly near the ventricular apex on a lateral chest radiograph. A lead within the coronary sinus projects superiorly and to the left over the heart on a frontal chest radiograph and is situated posteriorly along the course of the atrioventricular groove on a lateral chest radiograph.
