A 69 year old male patient with mild non ischemic cardiomyopathy, baseline EF of 47%, received a dual chamber pacemaker with a direct left bundle branch lead for complete heart block. 3830 lead was inserted intraseptally according to published recommendations with a resultant QRS of 103 ms. One month later patient presented with severe heart failure. Echocardiogram showed significant dyssynchrony and EF of 21%. Patient remained highly symptomatic despite aggressive medical therapy and exclusion of other causes of heart failure. An upgrade to a bi-ventricular pacing system was performed. At 1 month follow up, patient was no longer exhibiting heart failure symptoms, EF had improved back to baseline (46%) with improvement in dyssynchrony.