Objective:To learn the anatomic features of the axillary vein in chronic heart failure (CHF) patients and to explore the feasibility and safety of left ventricular lead placement via axillary vein pathway in cardiac resynchronization therapy procedure. Methods: Fifty nine CHF patients (35 male with mean age of 62.32 ± 10.33 years old) underwent CRT or CRTD device implantation from January 2013 to February 2015 were randomly divided into the axillary vein group (n=23) and the subclavian vein group (n=36). The successful rate and time-consuming of the left ventricular lead piacement and related complications were compared. Sixty seven patients (41 male with mean age of 64.34 ± 11.77 years old) underwent dual-chamber pacemaker (DDD) implantation were recruited during the same period for comparison of axillary vein diameter with CHF patients. All patients received axillary venography before procedure. Diameter of the axillary vein was compared between CRT/CRTD patients and DDD patients. Results: All patients successfully implanted the devices. There were no significant differences of axillary vein diameter between the CRT/CRTD group and the DDD group [(10.77 ± 2.19) mm vs. (10.11 ± 2.02) mm, P > 0.05]. The successful implantation time of left ventricular lead was similar between the two groups. No left ventricular lead implantation related complications occurred. There were no significant differences of pacing threshold, sense and impedance of right atrium, right ventricle and left ventricular lead (P > 0.05). Conclusion: The diameter of the axillary vein was normal in chronic heart failure patients. The left ventricular lead placement via the axillary vein is safe and feasible in cardiac resynchronization therapy procedure.