Fig. 1.

Atrial septal puncture by a superior approach with radiofrequency and introduction of the lead superiorly. a The assemblage of the deflectable sheath, the Attain Select II sheath and dilator positioned against the fossa ovalis with the guidewire just protruding from the dilator. b On intracardiac echocardiography, the tenting (solid arrow) of the inter-atrial septum by the sheaths (dashed arrow) is shown. c The Attain Select II with the dilator (dashed arrow) is advanced over the guidewire towards the left ventricle. The deflectable sheath (solid arrow) remains at the right atrial surface of the septum. d Final position of the Select Secure lead with the Attain Select catheter withdrawn in the steerable guiding catheter at the right side of the septum. See text for full discussion