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The leadless pacemaker, Micra Transcatheter Pacing System (Medtronic, Minneapolis, MN, USA) has been proposed as an alternative to conventional transvenous pacemakers. Micra implantations on the ventricular septum, particularly mid-septum, are recommended to avoid severe complications including cardiac perforations. However, Micra implantations on the ventricular mid-septum are difficult using the conventional gooseneck-shape technique in patients with anatomical problems, and no reliable techniques for implantation on the mid-ventricular septum have been established yet. An 89-year-old man underwent a Micra implantation for sick sinus syndrome. The Micra could not be deployed on the ventricular mid-septum using the gooseneck-shape technique because the Micra delivery catheter’s tip slipped toward the ventricular apex. Thus, the Micra was successfully implanted on the ventricular mid-septum using the “α-loop technique”, which enabled the catheter tip to adequately come in contact with the mid-ventricular myocardium. This novel technique may be an alternative method for Micra implantations on the ventricular mid-septum.

Keywords: Micra transcatheter pacing system; Gooseneck-shape technique; Right ventricular mid-septum; α-loop technique; Leadless pacemaker; Catheter manipulation