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In: Cohn LH, Edmunds LH Jr, eds. Cardiac Surgery in the Adult. New York: McGraw-Hill, 2003:.

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FIGURE 55-13 Dual-chamber pacemaker illustrates low, right lateral atrial lead placement. This location, particularly advantageous after obliteration of the atrial appendage at heart surgery, requires a positive fixation lead. P-wave amplitude in this location is often acceptable when other sites fail. If phrenic nerve stimulation is observed with 10-volt stimulation at 0.50-ms pulse width, however, the lead tip should be repositioned.

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