 Heart failure is a major concern in the country. Patients with heart failure not only have a very poor quality of life, they're also at a higher risk of sudden cardiac events when compared to the general population. Advances in pharmacotherapy have made a huge change in the lives of these patients with heart failure. Unfortunately, there's still a lot to be desired with drugs alone, so drugs do not address the issue of sudden cardiac arrest and, moreover, they don't improve the ejection fraction to a great extent. What we have seen is despite adequate pharmacotherapy, the national history is still very, very poor. Over a period of time, these heart failure patients, generally the left-winged equals tend to dilate and remodel, their NYC class becomes worse, and eventually it leads to a shortened lifespan. Off-flat devices have come to help these patients with heart failure, so resynchronization therapy, with or without defibrillators, is really a boon for patients with heart failure. So what we do in resynchronization therapy is we implant small devices like a pacemaker, which are done under local anesthesia with some sedition. These devices are implanted beneath the left collar bone, and they tend to electrically resynchronize the heart. So a portion of patients with heart failure, especially patients with left-banded branch block, have got electrical dyssynchrony, so areas of the heart don't meet together in sync, and this results in worsening pump function. So with resynchronization therapy, what we're trying to achieve is to synchronize and normalize the electrical activation of the heart, which eventually adds to improvement in the ejection fraction. So resynchronization therapy has been here for more than a decade, and it's made wonders in the lives of patients with heart failures. So it's an add-on therapy to drugs, which increases the overall pumping of the heart. So in addition to resynchronization therapy, if the patient is implanted defibrillator, it definitely reduces the risk of sudden death in these patients. So as I said earlier, patients with heart failure are at a higher risk of sudden cardiac events. The only concern with resynchronization therapy was the cost. In a country like India, it is still pretty decently, I mean pretty highly priced, and that's why many people who deserve the therapy don't end up not receiving the same thing. So thankfully for us, a new form of resynchronization therapy, which is called as physiological pacing, is just coming into work, and then in the end it gives the same effect as resynchronization therapy. But unlike conventional resynchronization therapy, in physiological pacing, we use just two leads instead of three, and because we're using only two wires, we can use a routine pacemaker, so it ends up being a little more costlier than a conventional pacemaker. But the effect is as good as a resynchronization therapy. At least the initial data shows that it is good enough. It does make a difference in the lives of heart patients. So the patient you saw in the video had undergone a procedure called as left bundle pacing. You know this is a new procedure. It's a form of a resynchronization therapy wherein we directly pace the left bundle or the his bundle and achieve electrical activation or normalization of the electrical activation of the heart. So still it's very early stages in physiological pacing. The data is just a couple of years old, but it's promising. And we're yet to offer it as a first line for patients with heart failure. But the biggest advantage what I see of physiological pacing is the cost. It dramatically reduces the cost of cardiac resynchronization therapy. So as I said earlier, resynchronization therapy will definitely be helpful in patients in heart failure. But unfortunately not all patients with heart failure will benefit from resynchronization therapy. So the candidates who generally benefit are people who have a left bundle branch block with the QRS duration of more than 150 milliseconds or at least 120 milliseconds. Females with normal coronaries who do not have coronary artery disease tend to do better with resynchronization therapy.