Deployment of left ventricular lead from the ipsilateral side of central vein obstruction.

Cardiac resynchronisation therapy improves symptoms and reduces mortality in patients with chronic heart failure. In patients with previously implanted devices, particularly automatic defibrillators, central venous stenoses provide a challenge to upgrading to resynchronisation devices. We present a patient with central venous obstruction secondary to previously implanted defibrillator leads, in whom we achieved coronary sinus pacing through the ipsilateral internal jugular vein.