Pacemaker Implantation without Fluoroscopy and Guided by Anatomical Mapping

with the syncopal episode. The patient has no other known comorbidities and no significant family history. A transthoracic echocardiogram revealed a normal left ventricular ejection fraction (68%), normal heart valves, and normal right ventricular size and function. The electrolytes and thyroid function were normal. In addition, an exercise electrocardiographic stress test was normal. She was therefore referred for a pacemaker implantation, and given her ongoing pregnancy, an alternative technique was applied. The patient was brought to the electrophysiology laboratory, and prior to commencing the procedure, a fetal heartbeat monitor was installed, and the entire procedure was followed by an obstetrician. The patient was sedated, using propofol, and both the right groin as well as the left pectoral region were ??? and draped using alcoholic chlorhexidine. Under local anesthesia, with 2% lidocaine 10cc, the right femoral vein was