Cardiac pacing in children is done most often following cardiac surgery for congenital heart disease (CHD). This pacing is usually temporary. Following open heart surgery children frequently exhibit cardiac dyssynchrony secondary to conduction abnormalities or regional wall motion abnormalities. Often, damage to the conduction system is an unavoidable result of the operation itself. Regardless of the extent of the conduction abnormality, most patients operated on for congenital heart disease undergo a period of decreased cardiac function related to several factors, including: pre-existing myocardial disease; cardiopulmonary bypass; and residual cardiac lesions.7, 14 The decrease in cardiac performance and, therefore, the risk to the patient's life, can be aggravated by the presence of cardiac dyssynchrony. The benefits of CRT are just beginning to receive attention in the setting of pediatric post-operative cardiac care. 15