Case 2
A 79 year-old male with past medical history of ischemic cardiomyopathy and systolic heart failure (EF <30%) with a dual chamber ICD initially placed 8 years prior, previous AV nodal ablation and upgrade to a Bi-V ICD one year prior and subsequent device infection requiring extraction and reimplantation who was referred for LV endocardial lead placement after an unsuccessful attempt to re-implant a CS lead from the right. During placement there were no significant variations from the described procedure above. There were no complications including stroke or TIA. He did well until 2 years post procedure when he developed renal failure and ultimately opted for hospice care. There was no follow-up evaluation of EF and functional status was NYHA class III.