Figure 1: Left ventricular endocardial lead placement procedure: Brockenbrough needle and sheath in the RA (A) . Snare is tightened over transseptal sheath/needle (B) . Snare and sheath in the left ventricle with transseptal apparatus removed (C) . Sheath still in place in the left ventricle (D) . LV lead is advanced through sheath from the axillary vein into the LV (E) . Final procedural image with LV lead in the endocardium (F) .