Cardiac resynchronization therapy: the conundrum of predicting response in the individual patient.

Cardiac resynchronization therapy (CRT) was tested in pioneering experiences performed in France around 20 years ago. This electrical treatment was initially applied as a last resort treatment in patients with severe heart failure associated with left bundle branch block (LBBB). Despite the novelty of the approach and the limitations of implantable leads in those early stages, biventricular pacing rapidly moved from case report, and case series to randomized controlled trials (RCTs) such as MUSTIC study and to a RCT with blinded assessment of the effects, that is the MIRACLE study. The MIRACLE trial included implant of a CRT device followed by randomization to biventricular pacing ‘on’ or ‘off’ for 6 months with blinded assessment of the presence/absence of improvement in symptoms, heart failure status and quality of life.

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