The 69-year-old female patient with sick sinus syndrome was admitted to the hospital with symptoms of shortness of breath and lightheadedness. Due to her multiple episodes of significant bradycardia while being treated for her symptoms, it was recommended, and the patient agreed to the placement of a dual chamber pacemaker. Pre-Operative diagnosis. Symptomatic Sick. Sinus syndrome. Post-operative diagnosis. Symptomatic sick sinus syndrome. Procedure performed. Dual chamber Medtronic pacemaker placement. With active atrial and active ventricular leads. Using intraoperative fluoroscopy. (Three procedures are coded because three devices are inserted: one pacemaker generator and two cardiac leads.)