This is a multicenter, randomized, open-label, active-controlled safety study designed to enroll approximately 240 patients with symptomatic (New York Heart Association [NYHA] Class III or IV), decompensated CHF for whom treatment with dobutamine or Natrecor® is deemed appropriate. After a 24-Hour Baseline Holter Monitoring Period, patients are randomized to dobutamine or Natrecor® (0.015 or 0.03 µg/kg/min). The randomization is stratified by whether or not the subjects have a known history of Ventricular Tachycardia (non-sustained or sustained). Treatment assignment is open-label with regard to the study drug (dobutamine or Natrecor®); assignment to the two Natrecor® dose groups is double-blinded. Dobutamine is to be administered at a dose of at least 6 µg/kg/min. During the first 24 hours of study drug, each patient undergoes Holter monitoring. Study drug (dobutamine or Natrecor®) is administered for at least 24 hours as the single IV vasoactive agent for symptomatic, decompensated CHF. Other IV vasoactive agents such as milrinone, nitroprusside, nitroglycerin, and/or any dose of dopamine are not to be added to the study drug during the first 24 hours of therapy. Dobutamine is not to be added to the Natrecor® infusion during the first 24 hours of therapy. After 24 hours, the Holter monitor will be removed, and patients can remain on study drug, if appropriate. Natrecor® patients can continue on their fixed-dose Natrecor® regimens (still blinded to specific dose group assignment) for up to a maximum of 7 days (with or without the addition of other parenteral agents) or can switch to whatever treatment is appropriate, at the discretion of the investigator. Patients in the dobutamine treatment group can continue on study drug as long as appropriate, at the discretion of the investigator. Systemic hemodynamics (blood pressure and heart rate) are assessed at baseline, at 15 and 30 minutes, and at 3, 8, 16, and 24 hours following the initiation of study drug. The study hypothesis is that Natrecor® is not associated with increases in reported ventricular arrhythmias in patients being treated for symptomatic decompensated CHF. Continuous IV (intravenous) Infusion for at least 24 hours, and over 24 hours with discretion of Principal Investigator. Dobutamine starts at 5 mcg/kg/min, may be increased; Natrecor®, either 0.015 mcg/kg/min or 0.030 mcg/kg/min fixed dose for at least 24 hours, up to a maximum of 7 days.