Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Transvenous pacer has been removed and replaced by a permanent pacemaker , with leads in the right atrium and right ventricle . The right ventricular lead has a more superior course than typical , and is more superiorly located than the recent temporary transvenous pacing lead . There is no evidence of pneumothorax . The heart is upper limits of normal in size . Large hiatal hernia is demonstrated with adjacent atelectasis . Small pleural effusions are present bilaterally .
    OUTPUT:
    
Permanent pacemaker in place , with superior course of right ventricular lead as described . Dr . ___ was telephoned to discuss this finding at 8 : 55 a .m . on ___ at the time of discovery .