Case 4
A 78-year-old male with permanent atrial fibrillation on warfarin and longstanding dilated cardiomyopathy with depressed ejection fraction despite optimal medical therapy was referred for Biventricular upgrade. However, a previous attempt to place a coronary sinus lead was unsuccessful 2 months prior.  After discussion, the decision was made to attempt LV endocardial lead placement. The procedure was well tolerated without complications. Follow-up has been limited since the procedure with no repeat EF testing or assessment of functional status documented.