Methods
The procedure was performed according to the standard technique. however, electrical measures were not acceptable. Finally, acceptable position was obtained in mid RV septum. Electrical measurements showed R wave amplitude of 10 mV, pacing impedance of 830 Ω, and pacing threshold of 1.0 V @ 0.24 ms. Pull and hold test was acceptable. Finally, tether was cut, and delivery and introducer sheath were removed, and access site was closed using figure-of-eight suture. Patient was transferred into ward with good and stable condition.
Fluoroscopic oblique views was essential for a correct engagement of the tricuspid ring without injuries to the BTV. Left anterior oblique (LAO) view 40° was helpful to visualize the tricuspid annulus as a clock to be crossed exactly in the center. Right anterior oblique (RAO) view 30 was used to establish the correct advancement of the Micra delivery system across the tricuspid valve and to evaluate the proper distance of implantation site from the valve (Figure 1).