Patients with pacemakers or implantable cardioverter defibrillators (ICDs) may require an MRI exam of any body part. Clinical guidelines indicate that patient orientation in the scanner depends only on the body part under examination. Lead tip heating (LTH) is also a function of patient orientation. In this study our objective was to compare LTH for head-first and feet-first orientations for five pacemakers with realistic implant configuration in the ASTM torso phantom. Our results suggest that depending on the anatomical region examined, proper patient orientation in the MRI scanner can reduce LTH.