Current status and future expectations for multisite pacing in heart failure.

The number of patients with congestive heart failure (CHF) has achieved astonishing proportions. It is a debilitating and usually lethal condition, aside from being responsible for an enormous proportion of health care expenditures. Advances in medical therapy have not been sufficient to significantly improve prognosis, and heart transplantation can only benefit a minority of patients. Biventricular pacing has emerged as a promising form of therapy for patients with severe, medical refractory CHF with ventricular conduction defects. However, there are many technical issues to be solved, and better methods of selecting patients who respond favorably to this form of therapy are yet to be developed. This article reviews the rationale, delivery modes, and available data supporting multisite cardiac pacing as an alternative form of therapy for the failing heart.