Fig. 2.

Transfemoral introduction of the lead with transvenous tunnelling towards the generator pocket. a The Mullins sheath (solid arrow) has passed the septum and the Attain Select guiding system (long dashed arrow) has been directed over a guidewire into the left ventricle. The tip of the Attain Select is rotated towards the basal posterolateral wall of the left ventricle. The Select Secure lead (short dashed arrow) is positioned against the myocardium. b The stiff guidewire (solid arrow), introduced via the Mullins sheath towards the superior vena cava, is captured by a snare (dashed arrow), which was introduced via the subclavian vein. c The lead secured into the angiocatheter is introduced into the 12 F sheath that emerges retrogradely from the femoral vein through the same puncture site as the previously introduced lead. d The 12F sheath (solid arrow) and the angiocatheter (long dashed arrow) with the Select Secure lead (short dashed arrow) are pulled back through the venous system. The tip of the sheath is still in the vena cava inferior, but the lead has already been pulled into the vein