Case Study: Cardio Note Procedure performed: Placement of permanent pacemaker, dual chamber. Indications: A definite diagnosis of atrial fibrillation was made, and I determined during the office visit yesterday that a permanent dual-chamber pacemaker device would be inserted today. Postoperative diagnosis: Atrial fibrillation. Procedure: The patient was prepped and draped in the usual sterile fashion. A needle was passed into the left subclavian vein, and good blood was noted. The guidewire was passed through the needle, and the needle was removed. The dilator and introducer were then passed over the wire. Once in position, the dilator and guide wire were removed and leads were placed. Leads were placed in the right ventricle and atrium, sequentially. I then turned to placement of the pulse generator. A subcutaneous pacemaker pocket was created in the right anterior chest wall, and the pulse generator was placed in the pocket. A subcutaneous tunnel was made, and the leads were threaded thru and attached to the generator. The pocket was sutured in the usual sterile fashion, and the patient tolerated the procedure well. A chest x-ray was ordered to verify placement of leads and generator upon completion of the procedure.