Vitatron implantable transvenous leads are designed to be used with pulse generators as part of a cardiac pacing system. Contraindications include patients with tricuspid valvular disease, mechanical tricuspid heart valves, and patients for whom a single dose of 1.0 mg dexamethasone sodium phosphate may be contraindicated. It can also be contraindicated with absence of a right atrial appendage. In using leads like the Vitatron implantable transvenous leads an anchoring sleeve is a must. It must be handled with great care at all times. Any severe handling with surgical instruments, excessive force when inserting a stylet may cause permanent damage to the lead. Chronic repositioning may affect a steroid lead's low-threshold performance.