Given that he is pacemaker dependent, we first began by placing a temporary pacemaker.  The right neck was prepped and draped in a sterile fashion.  Access to the Right IJ was obtained using the seldinger technique with ultrasound guidance.  A 6 Fr sheath was then placed over the guidewire and then flushed.     A temporary pacing balloon swan catheter was then placed through this into the right ventricle, with ECG pacing morphology used to guide placement.