Permanent pacemaker insertion is considered a minimally invasive procedure. Transvenous access to the heart chambers under local anesthesia is the favored technique, most commonly via the subclavian vein, the cephalic vein, or (rarely) the internal jugular vein or the femoral vein. The procedure is typically performed in a cardiac catheterization laboratory or in an operating room (OR). The pacing generator is typically placed subcutaneously in the infraclavicular region. Occasionally, pacemaker leads are implanted surgically via a thoracotomy, and the pacing generator is placed in the abdominal area. Single-chamber and dual-chamber pacer insertion can be accomplished from either left or right pectoral sites. After appropriate sedation, the chest is prepared with an antiseptic solution, and the area is covered with sterile drapes to keep the incision area as clean as possible.

Temporary cardiac pacing provides electrical stimulation to a heart that is compromised by disturbances in the conduction system, resulting in hemodynamic instability. A temporary pacemaker to treat a bradydysrhythmia is used when the condition is temporary and when a permanent pacemaker is either not necessary or is not immediately available. Complications are common and include infection, local trauma, pneumothorax, arrhythmias and cardiac perforation.