Congestive heart failure (CHF) has become a major health problem. Despite improved pharmacologic therapies, refractory symptoms and high mortality remain a challenge in such patients. There has been increased interest in the application of ancillary nonpharmacologic therapies for CHF management, such as implantable pacemakers, defibrillators, and/or left ventricular assist devices. Various methods of cardiac pacing are discussed and contrasted in this chapter, with the focus on biventricular pacing and cardiac resynchronization therapy for treatment of CHF. Cardiac resynchronization therapy has now become a part of standard therapy for patients with severe symptomatic CHF and intraventricular dyssynchrony.