Analysis of 120 heart failure patients receiving cardiac resynchronization therapy (CRT) revealed that baseline heart measurements—specifically left ventricular end-diastolic diameter and ejection fraction—were more predictive of one-year treatment success than pacing strategies or device positioning. The study achieved 42.5% response rates in patients without typical left bundle branch block patterns, with baseline structural factors showing an area under curve of 0.766 for prediction accuracy. This finding challenges the conventional emphasis on procedural optimization during CRT implantation. For the millions of heart failure patients worldwide, this suggests that careful patient selection based on pre-existing heart structure may be more important than technical device placement variations. The research addresses a critical gap since CRT response varies widely in non-left bundle branch block patients, who represent a substantial portion of heart failure cases. However, this preprint study awaits peer review, and the retrospective design limits causal conclusions. The moderate response rate also highlights that even with optimized selection criteria, CRT remains effective for fewer than half of this patient population, underscoring the need for continued refinement in both patient selection and procedural approaches.