For more than half a century, pacemakers have proven to be one of the most successful medical interventions. In an effort to approximate normal cardiac physiology, pacemakers have evolved from simple to highly sophisticated devices. There is a growing demand, not only to improve overall mortality and safety in patients with existing devices, but also to improve patient quality of life. With growing evidence of left ventricular dysfunction and desychronization due to prolonged right ventricle apex (RVA) pacing, alternative ways to avoid excessive RVA pacing have been devised. In the pursuit of providing safe long-term pacing, biventricular pacing is emerging as an attractive option.