The procedure is usually done under local anaesthesia, with or without sedation, in a cardiac catheterisation laboratory. A pacemaker generator is implanted under the skin near the collarbone, usually on the left side of the chest (although the right side is possible). A standard or dedicated pacing lead is inserted through the subclavian, cephalic or axillary vein into the heart. This is done under fluoroscopic guidance and continuous electrocardiogram monitoring or mapping, and using a standard or specially designed His-delivery sheath. It is then positioned and secured to the His bundle, where it can directly stimulate the His-bundle fibres. An electrogram from the tip of the lead is used to ensure a His signal and that the pacing lead is correctly placed. The pacemaker generator is securely connected to the His-bundle lead. The generator can be adjusted transcutaneously to ensure optimum His-bundle pacing.