A 68-year-old woman was transferred to Trinity in CHF. A dual chamber placement was placed a year ago at the outside hospital for a total heart block and developed Pacemaker Syndrome. Pacemaker S yndrome is a combination of decreased cardiac output , loss of atrial contribution to ventricular filling, and loss of peripheral resistance response. When the timing between the two chambers loses synchronization, less blood is delivered on each beat. The patient required two procedures; a lead extraction from the dual-chamber pacemaker and the implantation of the biventricular pacemaker to synchronize her ventricles.