Biventricular pacing therapy for congestive heart failure: a review of the literature.

Biventricular pacing is a new therapy for patients with congestive heart failure and mechanical dyssynchrony. Its therapeutic intent is to activate both ventricles simultaneously, thus improving the mechanical efficiency of the ventricles. Preliminary evidence indicates improvement in hemodynamics, quality of life, and exercise capacity in patients in sinus rhythm as well as in patients with atrial fibrillation. An improvement in diastolic filling, a decrease in mitral regurgitation, and more efficient systolic ejection are proposed as the mechanisms behind these benefits. In addition, some evidence indicates that the frequency of ventricular arrhythmias is decreased. All clinicians involved in the management of patients with congestive heart failure eagerly await the results of ongoing trials. The results of these trials will define which patients are eligible for this therapy, which patients will derive the most benefit from it, and its effect on morbidity and mortality.