There are different types of heart failure and different types of pacemakers. If a patient with heart failure has a low ejection fraction despite medications and a prolonged electrical time of activation of their heart’s contraction then some patients could benefit from a special type of pacemaker called a Bi-ventricular pacemaker. A Bi-ventricular pacemaker has leads that activate the left and right ventricle and can improve the timing of the activation of the hearts contraction. If this is achieved then cardiac output is achieved and may help patients feel better and exercise further.