Although the drug therapies developed over the last decades have improved the prognosis of congestive cardiac failure, the condition remains a principal cause of mortality and hospital admission in the industrialised world. The hopes for gene therapy in cardiac failure are based on the possibility of acting on the underlying physiopathological mechanisms by the transfer of genetic material to the failing myocardium. A number of experimental studies targeting the regulation of the calcium ATPase of the sarcoplasmic reticulum, the pathways of beta-adrenergic desensibilisation and the pathways of apoptosis reported encouraging results. Although improvements in the efficacy and safety of techniques of vector construction and methods of delivery to the myocardium incite a certain optimism, the clinical benefits of gene therapy in cardiac failure have yet to be demonstrated.