Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Semi-upright portable AP view of the chest is provided . Midline sternotomy wires and sternal clips are again seen . There is a left chest wall pacer device with dual leads entering the region of the right ventricle and coronary sinus . The heart remains mildly enlarged . The lungs are clear . No effusion or pneumothorax is seen . Degenerative changes of the left shoulder are noted .
    OUTPUT:
    
Interval change of pacer with two leads entering the region of the coronary sinus and right ventricle .