Pacing for heart failure

Pacing for patients with severe heart failure without bradyarrhythmia has b een proposed as an addition to medical therapy over the past decade. Altera tion of the normal electrical activation sequence of the heart modifies its mechanical action, especially when ventricular function is poor. Both the site of ventricular-lead placement and timing with the atria have been mani pulated in attempts to alleviate the symptoms of heart failure. Most recent ly, in addition to the conventional two leads used for pacing, a third lead to pace the left ventricle has been advocated in some patients with heart failure. We review the evidence for pacing in heart failure.