Pacemaker installation is performed under local anesthesia and the patient is conscious throughout the procedure. The subclavian vein is usually selected as the puncture point, venous access is established, and the pacemaker leads are placed into the heart chambers. In the case of a dual-chamber pacemaker, one electrode is placed in the right heart ear and the other in the right ventricle, and the position of the electrodes is determined from the X-ray. The pacemaker electrodes are then connected to the pacemaker, and finally the skin is cut in the chest to create a capsule into which the pacemaker is buried and then the skin is sutured.