Medical treatment for left ventricular (LV) systolic dysfunction and congestive heart failure has improved quality of life for patients but mortality rates have remained unaffected. For a subgroup of such patients with interventricular conduction delays and ventricular contraction dyssynchrony, cardiac resynchronization by placement of a LV epicardial lead is a new approach to management. We report 3 cases in which such electrodes were implanted under the guidance of minimally invasive thoracoscopy. In the first 2 cases it was decided to place the LV electrode using thoracoscopic guidance because of complications or technical difficulties in the percutaneous procedure. In the third case thoracoscopy was used because of deterioration of the patient's condition after implantation of a double-chamber pacemaker and shifting of the lead to the right ventricle. The literature on the anesthetic management of such patients is scarce. Although sedation with general anesthesia and single-lung ventilation is indicated for percutaneous procedures, that technique also proved adequate for the thoracoscopic procedures.