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Biventricular resynchronization therapy is recommended for patients presenting with left ventricular (LV) dysfunction and ventricular dyssynchrony. Implantation of a left ventricular (LV) lead fails in 5%–10% of patients in whom cardiac resynchronization therapy (CRT) is attempted. Conventional approach is not feasible due to anatomic abnormalities in coronary sinus (CS) and its branches or due to high pacing thresholds or phrenic nerve stimulation. We present a case of a 62 year old male in which, LV lead implantation through CS was failed and LV lead implantation was done via transseptal approach. We described that LV endocardial pacing is an alternative to CS pacing and needs a long-term follow up.