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.