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At present, many studies have shown that QRS complex duration is not completely linear with ventricular mechanical asynchrony, however, synchronous ventricular electrical activation is an important prerequisite for normal systole and diastolic functions of the ventricle. Patients with chronic heart failure (HF) often have ventricular systolic dysfunction. Although in the early stages of HF, the heart makes adaptive changes, once the compensatory limit is exceeded, it can lead to heart remodeling and serious damage to heart functions. Electrocardiography and mechanical remodeling is influenced by multiple factors such as cardiac structure, and cellular and molecular levels, which is manifested by prolonged QRS complex duration in the ECG. In the treatment of HF, in addition to traditional pacemakers, the emerged conduction system pacing in recent years is more suitable to the characteristics of physiological conduction, not only significantly shortening the QRS complex duration but also significantly improving ventricular mechanical synchronization. This review summarizes the possible mechanisms of electrical-mechanical asynchrony in patients with chronic HF, and its relationship with QRS complex duration. It also covers the influence of the two factors on cardiac function. [ABSTRACT FROM AUTHOR]