Conclusion
Direct left bundle branch pacing has become a subject of interest as a novel means for ventricular stimulation and possibly cardiac resynchronization therapy5. Certain technical characteristics of this method may be complimentary to His bundle pacing. We describe the first case of worsening cardiac function and progressive CHF most likely attributable to direct left bundle branch pacing, both eventually corrected by the addition of the standard left ventricular pacing lead. Long term follow up series of direct left bundle branch pacing will be required to confirm the sustained benefit with this new modality.