Narrow complex qrs and cardiac resynchronization therapy; congestive heart failure

As an adjunct to medical therapy for congestive heart failure and lv systolic dysfunction in patients with a wide qrs complex on ekg and symptomatic despite optimal medications, cardiac resynchronization therapy (crt) which involves implanting a pacemaker with an atrial, rv and lv lead helps with symptom control.  The attached study from nejm shows that in people without a widened qrs (<130 msecs), the intervention is not helpful.

http://www.nejm.org/doi/full/10.1056/NEJMoa1306687?af=R&rss=currentIssue

 

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