Single Chamber Pacemaker Lead Placement

Ventricular Lead Placement

The American College of Cardiology recommends that a single chamber pacemaker lead be placed in the right ventricle, most commonly at the right ventricular apex, depending on the clinical indication 1, 2
The lead is positioned in the right ventricular apex, which is the traditional and most frequently used site, with the lead passing through the tricuspid valve and advancing along the floor of the right ventricle to reach the apex 3, 4, 5
Ideal positioning on chest radiograph shows the electrode tip at the right ventricular apex with the tip turned down slightly 4, 5

Atrial leads are positioned in the right atrial appendage, requiring a preformed "fish hook" shape and leftward orientation, with the tip pointing upwards into the right atrial appendage for stable positioning 3, 4, 5
On lateral chest radiograph, atrial electrode tips should point forwards toward the anterior chest wall 4, 5

The American College of Cardiology indicates that ventricular-only pacing (VVI mode) is suitable for patients with permanent atrial fibrillation or longstanding persistent atrial fibrillation with no plan for rhythm restoration, symptomatic bradyarrhythmias when atrial hemodynamic contribution is not significant, and following AV junction ablation for rate control 1, 2, 6
Atrial-only pacing (AAI mode) is recommended for patients with sinus node dysfunction with intact AV conduction, and when ventricular pacing is not required 1, 2, 6
Single chamber ventricular pacing (VVI) is contraindicated when pacemaker syndrome is present or anticipated, as loss of AV synchrony can cause symptoms including light-headedness, syncope, or palpitations 6