CRT—now framed as cardiac physiologic pacing—remains a cornerstone for HFrEF patients with LVEF ≤50% and either high ventricular pacing burden or a wide QRS, with the biggest gains in LBBB and QRS ≥150 ms. ⚡🫀📈

Traditional biventricular pacing has randomized-trial evidence (>10,000 patients) showing better symptoms, quality of life, remodeling, fewer HF hospitalizations, and survival benefit in selected groups; meanwhile His bundle and left bundle branch pacing are rapidly expanding options, with large randomized trials underway to define comparative efficacy and safety. 🧠🔧🔬