De novo implantation vs. upgrade cardiac resynchronization therapy: a systematic review and meta-analysis

Annamaria Kosztin, Mate Vamos, Daniel Aradi, Walter Richard Schwertner, Attila Kovacs, Klaudia Vivien Nagy, Endre Zima, Laszlo Geller, Gabor Zoltan Duray, Valentina Kutyifa, Bela Merkely

Research output: Contribution to journalReview article

7 Citations (Scopus)

Abstract

Patients with conventional pacemakers or implanted defibrillators are often considered for cardiac resynchronization therapy (CRT). Our aim was to summarize the available evidences regarding the clinical benefits of upgrade procedures. A systematic literature search was performed from studies published between 2006 and 2017 in order to compare the outcome of CRT upgrade vs. de novo implantations. Outcome data on all-cause mortality, heart failure events, New York Heart Association (NYHA) Class, QRS narrowing and echocardiographic parameters were analysed. A total of 16 reports were analysed comprising 489,568 CRT recipients, of whom 468,205 patients underwent de novo and 21,363 upgrade procedures. All-cause mortality was similar after CRT upgrade compared to de novo implantations (RR 1.19, 95% CI 0.88–1.60, p = 0.27). The risk of heart failure was also similar in both groups (RR 0.96, 95% CI 0.70–1.32, p = 0.81). There was no significant difference in clinical response after CRT upgrade compared to de novo implantations in terms of improvement in left ventricular ejection fraction (ΔEF de novo − 6.85% vs. upgrade − 9.35%; p = 0.235), NYHA class (ΔNYHA de novo − 0.74 vs. upgrade − 0.70; p = 0.737) and QRS narrowing (ΔQRS de novo − 9.6 ms vs. upgrade − 29.5 ms; p = 0.485). Our systematic review and meta-analysis of currently available studies reports that CRT upgrade is associated with similar risk for all-cause mortality compared to de novo resynchronization therapy. Benefits on reverse remodelling and functional capacity improved similarly in both groups suggesting that CRT upgrade may be safely and effectively offered in routine practice. Clinical Trial Registration: Prospero Database—CRD42016043747.

Original languageEnglish
Pages (from-to)15-26
Number of pages12
JournalHeart Failure Reviews
Volume23
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

Keywords

  • CRT upgrade
  • Cardiac resynchronization therapy
  • De novo CRT
  • Heart failure
  • Meta-analyses
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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