The implantation of permanent pacemakers and ICDs (Implantable Cardioverter Defibrillators) is performed in a sterile environment under local anesthesia. A small incision is made in the area where the device will be placed, typically on the chest wall, below the collarbone or near the shoulder. Subsequently, the pacemaker's generator is placed under the skin through this incision. The electrode(s) are carefully advanced through a vein into the targeted chambers of the heart and positioned. Finally, these electrodes are securely connected to the generator, completing the system.