Despite a general reduction in the incidence of coronary artery disease world wide, heart failure (HF) incidence is increasing.  The occurrence of HF result in significant limitation of quality of life and daily activities.     The standard therapies for HF include diuretics, angiotension converting enzyme inhibitors, spironolactone and beta blockers.  Despite these therapies, about  37% of patients with Class IV heart failure died within the first year of presentation, many due to the occurrence of ventricular tachyarrhythmias.  Thus device therapy becomes important for their management.     About 10-20% of patients with HF have intraventricular conduction