ALternate Site Cardiac ReSYNChronization (ALSYNC) Study

Inclusion Criteria: * Cardiac Resynchronization Therapy candidate/recipient with: * Failed Cardiac Resynchronization Therapy implant or required CRT replacement without viable access to Coronary sinus or, * Sub-optimal Coronary sinus anatomy per investigator discretion or, * Worsened or unchanged clinical status after Cardiac Resynchronization Therapy implant * Patients able and willing to take optimal Vitamin K antagonist therapy (International Normalized Ratio (INR) of 2-4) * Patients willing to sign and date the Patient Informed Consent form * Patients 18 years of age or older * Patients able and willing to comply with the protocol, and is expected to remain available for follow-up visits Exclusion Criteria: * Patients having contraindications to Vitamin K antagonist therapy * Patients contraindicated for \< 100 micrograms beclomethasone dipropionate * Patients unable to tolerate an urgent thoracotomy * Documented (previous) ischemic or hemorrhagic stroke * Patients with known previous atrial septal defect closure, or history of mural thrombus that has not been resolved * Patients with documented atrial fibrillation AND increased stroke risk as determined by the Congestive Heart Failure, Hypertension, Age(2), Diabetes, Stroke(2), Vascular disease, Age, and Sex Category (CHA2DS2-VASc) Score of equal to or greater than 5 * Patients with unstable angina pectoris or who have had an acute myocardial infarct within the past 30 days * Patients with known atrial septum defect (ASD) and/or left superior vena cava * Patient with known internal carotid artery stenosis of greater than 50% * Patients diagnosed with peripheral artery disease that are expected to undergo stenting within the next three months * Patients who have had a Coronary artery bypass graft or stent within the past three months * Patients with history of mitral or aortic valve repair or replacement * Post heart transplant patients (patients waiting for heart transplant are allowed in the study) * Patients currently undergoing dialysis treatment * Patients with ongoing chemotherapy and radiation therapy that may have an effect on cardiac function * Patients with ongoing Adverse Events from a previous Left Ventricle lead implant attempt * Patients enrolled in any concurrent drug and/or device study that may confound the results of this study * Patients who are not expected to survive more than twelve months * Patients with exclusion criteria required by local law