An implantable medical device having a housing that encloses a pulse generator and a sensing module includes a housing-based cathode electrode electrically coupled to the pulse generator and to the sensing module. A sensing extension extending from the housing proximal end includes an anode electrode electrically coupled to the sensing module for sensing cardiac electrical signals. The sensing extension includes a flotation member that causes the sensing extension to extend away from the housing along a direction of flowing blood when the implantable medical device is deployed within a cardiovascular system of a patient.