Cardiac resynchronisation therapy (CRT) is a very effective treatment for selected patients with severe and mild heart failure (HF), impaired left ventricular (LV) function and a wide QRS complex. Findings from randomised clinical trials (RCTs) and numerous observational studies have provided insights as to which patients benefit the most. Technological advances, such as the quadripolar lead and LV endocardial systems have made CRT more effective and more widely available. While indications for CRT are unlikely to change in the foreseeable future, this review discusses how developments over the next 10 years may see progress with leadless CRT systems, perhaps in combination with a subcutaneous device.

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