( A ) Fluoroscopic image (anteroposterior projection) demonstrating the Channel sheath in the right atrium via the femoral vein, and a guidewire exiting the sheath and traversing the inter-atrial septum into the left atrium (white arrows). The Channel sheath has been used to enlarge the trans-septal puncture hole and following this has been withdrawn back into the right atrium to allow access of the steerable introducing catheter into the left atrium. The steerable introducing catheter (white dotted arrow) is seen entering the right atrium from the PLSVC via the coronary sinus, and traversing the inter-atrial septum through the puncture site made by the Channel sheath. The left ventricular lead (black arrow) is seen entering the left heart through the steerable introducing catheter. ( B ) Fluoroscopic image (anteroposterior projection) demonstrating the final position of the LV lead on the lateral LV wall (white dotted arrow).