Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Cardiomegaly is stable , with an unchanged LVAD in standard position . A right atrial lead and another lead , which curves medially and posteriorly into the azygos vein , are new . The old right ventricular ICD lead and left pacemaker are unchanged in position . No pneumothorax , mediastinal widening , or pleural effusions .
    OUTPUT:
    
Status post left ICD upgrade , with one lead terminating in the right atrium and the other in the azygos vein . No pneumothorax , mediastinal widening , or effusions .