Dynamic cardiomyoplasty is a promising new technique that appears to effect symptomatic improvement in patients with NYHA class III heart failure. Objective improvement in systolic performance of the left ventricle appears small but remains to be further defined. No survival advantage has yet been realized, although this may be seen as the technique is further refined and operative risk curtailed. Mechanism of action may include a girdling effect that prevents progressive left ventricular dilatation. This effect may be independent of any role in augmenting systolic performance. Randomized clinical trials currently in progress will provide definitive answers within the next few years to these important questions.