Fig. 3.

Transapical surgical insertion of a left ventricular endocardial lead. a The Select Secure guiding system is introduced through the LV apex and bleeding controlled by tightening the purse string around it. b The Select Secure lead is introduced into the guiding system, which can be deflected by turning the knob. c The Select Secure lead is implanted, the sheath withdrawn before splitting, and the pursue string fortified with additional pledge material tightened around the puncture site. d X-ray of final position of the lead. The solid arrow indicates the exit site of the lead from the left ventricle, the dashed arrow the anchoring site of the lead at the ribcage