A severely dilated heart from a patient with congestive heart failure (who had a heart transplant)

Millions of patients all over the world suffer from congestive heart failure.  In this disorder, the heart cannot pump enough blood to satisfy the bodies needs.  patients with CHF are the equivalent of a car designed to run on eight cylinders which because of mechanical problems is forced to run on fewer then the original eight.  Thus, many patients only experience symptoms of CHF when they might need all eight cylinders (such as during exercise).  Other patients with more severe CHF have symptoms with minimal exertion or even at times at rest.  Symptoms of CHF include shortness of breath and difficulty with lying flat.

Many medications have been developed to treat CHF.  Unfortunately, for many patients even medications don't relieve the symptoms of CHF and these patients suffer continuous shortness of breath and recurrent admissions to the hospital.

Recently, a number of line of evidence have definitively proven that certain patients with intractable symptoms of congestive heart failure might benefit from pacing in which both the left and right sides of the heart are paced at the same time.  The theory is that by pacing both the right and left ventricles at the same time the efficiency of the hearts pumping action can be improved.  Thus instead of running on four cylinders, patients might now be able to run on 6. Patients who benefit from biventricular pacing must manifest "conduction delay" on their EKG.  If the EKG does not show this finding, then there is no benefit to biventricular pacing.

Biventricular pacing is like adding a second spark plug to an engine; The engine now works more efficiently

 Many patients have seen remarkable improvements in their symptoms with some even being removed from heart transplant waiting lists.  However, these results are anecdotal and exactly how well this technique works remains to be seen.  The FDA has recently approved two devices for implantation in appropriate patients with CHF.  Currently Florida Electrophysiology Associates is the largest implanter of biventricular pacemakers and ICDs to treat CHF in south Florida.