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Meta-Analysis
. 2018 Jan;23(1):15-26.
doi: 10.1007/s10741-017-9652-1.

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

Annamaria Kosztin  1 , Mate Vamos  2   3 , Daniel Aradi  1   4 , Walter Richard Schwertner  1 , Attila Kovacs  1 , Klaudia Vivien Nagy  1 , Endre Zima  1 , Laszlo Geller  1 , Gabor Zoltan Duray  3 , Valentina Kutyifa  1   5 , Bela Merkely  6
Affiliations
Meta-Analysis

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

Annamaria Kosztin et al. Heart Fail Rev. 2018 Jan.

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.

Keywords: CRT upgrade; Cardiac resynchronization therapy; De novo CRT; Heart failure; Meta-analyses; Mortality.

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Conflict of interest statement

Mate Vamos reports lecture fees from Bayer, Pfizer and Spectranetics and support attending scientific meetings from Bayer, Boston Scientific, Pfizer and SJM, outside the submitted work. Endre Zima reports consulting fees and honoraria from Bayer, Biotronik, Boston Scientific, Innomed, Medtronic and St. Jude Medical for lectures, training and participation in clinical trials. Laszlo Geller reports consulting fees/honoraria from Biotronik, Medtronic, St. Jude Medical and Johnson & Johnson. Gabor Z. Duray served as a member of the steering committee of the Micra Study and reports research grants from Boston Scientific, Biotronik and Medtronic and speakers bureau/consulting fees from Biotronik, Medtronic, St. Jude Medical, Bayer and Boehringer Ingelheim. Bela Merkely reports consulting/lecture fees from Biotronik, Boston Scientific, Medtronic, St. Jude Medical and Terumo.

Annamaria Kosztin, Daniel Aradi, Attila Kovacs, Richard Schwertner, Valentina Kutyifa and Klaudia Vivien Nagy have nothing to disclose.

Figures

Fig. 1
Fig. 1
Flow chart of searching for publications
Fig. 2
Fig. 2
Risk of all-cause mortality (risk ratio) after de novo vs. upgrade CRT
Fig. 3
Fig. 3
Risk of heart failure events after de novo vs. upgrade CRT
Fig. 4
Fig. 4
a Change in ejection fraction after de novo vs. upgrade CRT. b Change in end-diastolic volume after de novo vs. upgrade CRT
Fig. 5
Fig. 5
a Change in NYHA functional class after de novo vs. upgrade CRT. b Change in QRS duration after de novo vs. upgrade CRT
See this image and copyright information in PMC

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