Background: Undoubtedly one of the most successful recent developments in the treatment of heart failure (HF) is cardiac resynchronization therapy (CRT). CRT aims to provide the failing heart with a mechanical advantage that can significantly reduce symptoms and mortality by treating ventricular dyssynchrony, a problem that affects up to one-third of patients with highly symptomatic systolic HF. Objectives: The aim of the current study was to evaluate the effect of different right ventricular (RV) lead positions on QRS complex duration post CRT device implantation in patients indicated for CRT as a treatment of chronic heart failure. Patients and methods: This clinical trial included 100 patients who underwent CRT device implantation as a treatment for heart failure, divided into 2 groups according to the site of RV lead implantation after confirmation of the RV lead position; 54 patients had the RV lead implanted in the RV Apex (RVA n=54) and 46 patients had the RV lead implanted in the RV Septum (RVS n=46). Results: There was no significant difference between the two groups regarding clinical response (NYHA Class) (P-value = 0.583), left ventricular ejection fraction (LVEF) (Δ EF 6.26 ± 1.64 in RVS group vs. 6.07 ± 1.43 in RVA group, P-value = 0.575) LVES diameter (47.70 ± 8.03 in RVS group vs. 45.39 ± 7.48 in RVA group, P-value = 0.141) or QRS complex narrowing (Δ QRS 60.93 ± 14.68 in RVS group vs. 54.07 ± 13.12 in RVA group, P-value = 0.182). Conclusion: Our results demonstrate that septal RV pacing in CRT is non-inferior to apical RV pacing regarding the primary objective of the study regarding clinical outcome, narrowing of QRS complex (Δ QRS) or LV reverse remodeling.