What is “biventricular pacing,” and when is it typically indicated?

Biventricular pacing involves the placement of two leads, one in each ventricle, to achieve better synchronization of ventricular contractions. This technique is primarily indicated in patients with heart failure who exhibit a widened QRS complex, often due to left bundle branch block. The goal of biventricular pacing, also known as cardiac resynchronization therapy (CRT), is to improve the coordination of the heart's pumping action, which can lead to enhanced cardiac output and reduced symptoms of heart failure. By pacing both ventricles simultaneously, the therapy promotes more effective and synchronized contractions, ultimately improving the patient's functional capacity and quality of life.

In comparison, using one lead in the right ventricle targets specific rhythm issues but does not address the synchronization challenges faced by heart failure patients. Pacing both atria would aim to increase heart rate rather than address the synchronization necessary in heart failure. External electrodes would generally be a short-term measure and do not provide the same benefits as the dual ventricular pacing strategy used in CRT.