Figure 2 . A) The Medtronic Attain Stability Quad lead. The 5.6-French non-electrically active side helix is positioned between the third and fourth electrodes. This picture is provided by Medtronic Japan. B) Once the LV lead is positioned as deep as possible, it is rotated clockwise and active temporary fixation is performed (arrow ①). C) Pulling the active fixation lead (arrow ②) while advancing the cannulation catheter deeper (arrow ③). Deep engagement of the cannulation catheter is obtained without the LV lead falling out. D) After deep engagement, the lead is rotated counterclockwise, fixation mechanism is released from the vein wall, LV lead is advanced to the desired position (arrow ④), and refixation is performed. Deep engagement of the cannulation catheter provides backup support and helps the LV lead to cross the lesion.
LV, left ventricular