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Editorial
Sep 12, 2011

CRT—Less Is MoreComment on “Impact of QRS Duration on Clinical Event Reduction With Cardiac Resynchronization Therapy”

Arch Intern Med. 2011;171(16):1462. doi:10.1001/archinternmed.2011.246

Cardiac resynchronization therapy has been a great advance in the treatment of selected patients with congestive heart failure and prolonged QRS interval. However, about one-third to one-half of patients who have a CRT device implanted do not respond. Since all patients with implants incur risk from this procedure, it is important to select those who will benefit from these invasive, high-risk devices, so that the benefits outweigh the risks. Sipahi et al find that patients with a QRS interval shorter than 150 milliseconds do not benefit from CRT, yet patients with QRS in the 120- to 150-millisecond range are currently receiving CRT. This study received our “Less Is More” designation because it identifies patients who do not derive clinical benefit from this invasive, high-risk device.

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