Three left ventricular leads required for improved haemodynamic and clinical status of a patient with very severe heart failure and a narrow QRS duration

A 65-year-old man with severe idiopathic cardiomyopathy was referred to our centre with New York Heart Association (NYHA) IV heart failure requiring continuous dobutamine infusion. Implantation of three left ventricle (LV) leads was associated with a significant haemodynamic improvement. After 6 months of tri-LV pacing the patient has improved NYHA class from IV to II and the LV ejection fraction from 15 to 21%.