Various techniques include advancing an implantable medical device comprising a tissue-piercing electrode toward the triangle of Koch region of the right atrium or through the coronary sinus to deliver cardiac therapy to or sense electrical activity of the left ventricle in the basal region, septal region, or basal-septal region of the left ventricular myocardium of a patient's heart. The tissue-piercing electrode may include an imageable material. The implantable medical device may include an imageable member made of an imageable material coupled to a housing or a lead of the implantable medical device. Image information representing the patient's heart and the imageable material may be acquired using two-dimensional imaging. Orientation information representing the implantable medical device may be generated based on the acquired image information.
