Biventricular ICD implant using endocardial LV lead placement from the left subclavian vein approach and transseptal puncture via the transfemoral route.

We present the case of a 72 years old diabetic male patient with severe dilated ischaemic cardiomyopathy and New York Heart Association functional class III symptoms and previous unsuccessful attempts to cardiac resynchronization therapy using the conventional epicardial left ventricular (LV) pacing through the coronary sinus. He also had an indication for ICD implantation. We successfully implanted a biventricular ICD system from the standard left subclavian vein approach using endocardial placement of the LV lead via a transfemorally performed transeptal puncture.