Description: Aims The clinical response to cardiac resynchronization therapy (CRT) is variable. Multipoint left ventricular (LV) pacing could achieve more effective haemodynamic response than single-point LV pacing. Deployment of an LV lead over myocardial scar is associated with a poor haemodynamic response to and clinical outcome of CRT. We sought to determine whether the acute haemodynamic response to CRT using three-pole LV multipoint pacing (CRT 3P-MPP ) is superior to that to conventional CRT using single-site LV pacing (CRT SP ) in patients with ischaemic cardiomyopathy and an LV free wall scar. Methods and results Sixteen patients with ischaemic cardiomyopathy [aged 72.6 ± 7.7 years (mean ± SD), 81.3% male, QRS: 146.0 ± 14.2 ms, LBBB in 14 (87.5%)] in whom the LV lead was intentionally deployed straddling an LV free wall scar (assessed using cardiac magnetic resonance), underwent assessment of LV + dP/dt max during CRT 3P-MPP and CRT SP . Interindividually, the LV + dP/dt max in relation to AAI pacing with CRT 3P-MPP (6.2 ± 13.3%) was higher than with basal and mid CRT SP (both P 〈 0.001), but similar to apical CRT SP . Intraindividually, significant differences in the LV + dP/dt max to optimal and worst pacing configurations were observed in 10 (62.5%) patients. Of the 8 patients who responded to at least one configuration, CRT 3P-MPP was optimal in 5 (62.5%) and apical CRT SP was optimal in 3 (37.5%) ( P = 0.0047). Conclusions In terms of acute haemodynamic response, CRT 3P-MPP was comparable an apical CRT SP and superior to basal and distal CRT SP . In the absence of within-device haemodynamic optimization, CRT 3P-MPP may offer a haemodynamic advantage over a fixed CRT SP configuration.