The invention is directed to medical lead designs that facilitate implantation of the leads through tissue. For example, the leads can implanted though tissue for placement of distal tips of the leads in locations on the opposing side of the tissue. The leads include fixation elements, such as flexible tines, that facilitate fixation to the tissue. The fixation elements can protrude from lead at a location more than 5 millimeters from the distal-tip of the lead such that when the distal tip has passed through the tissue, the fixation elements anchor in the tissue.