Floppy-tip technique

The floppy-tip technique may be used for achieving unusual atrial lead placement with a shaight active fixation lead. This is particularly useful for placement along the right lateral atrial wall. With the curved stylet retracted 1 to 2 in., the lead tip assumes a more lateral position. By simply advancing the lead to a point of contact, the fixation mechanism can be activated and threshold measurements carried out. 

Aetive fixation extendable rehactable leads that require the lead stylet to be fully advanced for placement preclude the use of this floppy-tip technique. Occasionally, in a setting of a giant right atrium, atrial endocardial lead contact is difficult to achieve. In this circumstance, a stiffer stylet is recommended. This stylet is preformed into a more exaggerated curve. Subsequently, frustration is encountered because the stiffer stylet with a more exaggerated curve will not negotiate the venous system in the superior mediastinum. 

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