Is permanent pacing for dilated cardiomyopathy and congestive heart failure a viable therapeutic option

Enthusiasm for permanent pacing as a therapeutic option for patients with dilated cardiomyopathy (DCM) and congestive heart failure (CHF) has waxed and waned since the early 1990‘s. The clinical results of standard dual-chamber pacing in these patients have been extraordinarily mixed, which can be attributed to small patient populations, marked heterogeneity of patients included, highly variable study designs and endpoints, and limited follow-up. Although investigators have postulated some mechanisms for improvement, there is still a great deal to learn to be able to reliably predict which patients with DCM and/or CHF will respond to permanent pacing. Biventricular pacing is emerging as having the greatest potential for patients with congestive cardiomyopathy. Although data is somewhat limited, triple-chamber, and in some cases four-chamber pacing will be the focus of future interest.