The procedure is usually done under local anaesthesia in a cardiac catheterisation laboratory. Fluoroscopic guidance is needed, and intracardiac echocardiography or contrast may be needed to guide implantation in the desired location in the heart chamber (right ventricle or atrium). For right ventricular leadless cardiac pacemakers, the proximal end of the leadless cardiac pacemaker is attached to a deflectable delivery catheter system. It is usually inserted percutaneously through the femoral vein or a vein in the neck (jugular access) using an introducer sheath. It is then moved into the right atrium, through the tricuspid valve into the right ventricle, and positioned near the apex or lower septum. An atrial device does not cross the tricuspid valve into the right ventricle. Once in place, the leadless cardiac pacemaker is securely implanted into the endocardial wall using a fixation mechanism. Electrical measurements are taken and, if satisfactory, the leadless cardiac pacemaker is released from the catheter and the catheter is removed. If the position is suboptimal, the leadless cardiac pacemaker can be detached from the endocardium and repositioned before the catheter is released.