in patients with advanced and refractory chronic heart failure initiated with the introduction of biventricular pacing in cardiac resynchronization therapy as a promising new therapeutic approach and was inducted into the treatment guidelines. The modern therapeutic devices now offer the ability to carry out an individual biventricular pacing with different temporal activation of the left and right ventricles (VV interval) and the time intervals between the atria and ventricles (AV interval) within the so-called sequential biventricular pacing. The acute hemodynamic effects of sequential CRT, as well as any changes over time were examined in the context of this work. The noninvasive measurement of left ventricular maximum rate of rise was found), both after one months (+ 12.1% and after four months (+ 3.33%) an increase in simultaneous biventricular pacing as an expression of increased inotropy. Then carried out an optimization of AV and VV time showed in the 1 months control, a further increase of dp / dt, at 6.11% compared to simultaneous biventricular pacing. This effect of optimization could be detected even after 4 months, this resulted in an increase in the rate of rise to 6.99% by optimizing to the simultaneous stimulation. Over time could be achieved by re-optimization of biventricular system, an increase of left ventricular rate of rise of 4.1% over the originally optimized programming.