Why QRS Duration Should Be Replaced by Better Measures of Electrical Activation to Improve Patient Selection for Cardiac Resynchronization Therapy

Elien B. Engels, Masih Mafi-Rad, Twan van Stipdonk, Kevin Vernooy, Frits W. Prinzen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

22 Citations (Web of Science)


Cardiac resynchronization therapy (CRT) is a well-known treatment modality for patients with a reduced left ventricular ejection fraction accompanied by a ventricular conduction delay. However, a large proportion of patients does not benefit from this therapy. Better patient selection may importantly reduce the number of non-responders. Here, we review the strengths and weaknesses of the electrocardiogram (ECG) markers currently being used in guidelines for patient selection, e.g., QRS duration and morphology. We shed light on the current knowledge on the underlying electrical substrate and the mechanism of action of CRT. Finally, we discuss potentially better ECG-based biomarkers for CRT candidate selection, of which the vectorcardiogram may have high potential.
Original languageEnglish
Pages (from-to)257-265
JournalJournal of Cardiovascular Translational Research
Issue number4
Publication statusPublished - Aug 2016


  • Electrocardiography
  • Vectorcardiography
  • Cardiac mapping
  • Cardiac resynchronization therapy
  • Left bundle-branch block

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