Implantation Procedure
Our approach to LP implantation follows the manufacturer’s recommended
implantation technique. Ultrasound-guided femoral access was obtained,
and an 8F femoral sheath was placed in the femoral vein. Through the
femoral sheath, a wire was inserted into the femoral vein, and
fluoroscopy was used to confirm the appropriate access. A right
ventricular angiogram was then performed through an angled pigtail
placed in the right ventricle. An intermediate-sized dilator was used to
increase the venotomy size. The Medtronic Micra implantation sheath with
dilator was then inserted over a stiff wire into the right atrium, and
the dilator was removed. The device and delivery system were then
flushed and checked for malfunctions. The device and delivery system
were then inserted into the implantation sheath. Multiple fluoroscopy
views and ventriculography were used to confirm appropriate implantation
site selection. Once an appropriate location was reached, the device was
deployed. Impedance, injury pattern, and capture thresholds were
measured to confirm that the implantation location was adequate, and the
device was repositioned if needed. Once the device was confirmed to be
securely in place, the delivery system was removed, and hemostasis was
achieved with a figure-of-eight stitch and manual pressure.