In patients with NYHA Class III or IV CHF despite medical management, reduced ejection fractions, and prolonged QRS duration, CRT improves functional and hemodynamic markers and reduces morbidity/mortality. Given the moderate implantation success rates, biventricular pacemaker insertions should only be done by experienced providers. The cost-effectiveness of CRT remains uncertain; additional effectiveness and cost data surrounding peri-implantation complications are required to determine whether CRT is sufficient value to be widely adopted.