There are two approaches used when inserting a pacemaker; the epicardial approach and the transvenous approach. Epicardial approach involves the opening the chest cavity and placing a lead on epicardial sac of heart while the transvenous approach involves accessing a vein and inserting an electrode into the vein. Epicardial approach for inserting pacemakers are divided based on approach to heart thoracotomy, upper abdominal or endoscopic.
