PMID- 29047028 OWN - NLM STAT- MEDLINE DCOM- 20190104 LR - 20190104 IS - 1573-7322 (Electronic) IS - 1382-4147 (Print) IS - 1382-4147 (Linking) VI - 23 IP - 1 DP - 2018 Jan TI - De novo implantation vs. upgrade cardiac resynchronization therapy: a systematic review and meta-analysis. PG - 15-26 LID - 10.1007/s10741-017-9652-1 [doi] AB - 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 (DeltaEF de novo - 6.85% vs. upgrade - 9.35%; p = 0.235), NYHA class (DeltaNYHA de novo - 0.74 vs. upgrade - 0.70; p = 0.737) and QRS narrowing (DeltaQRS 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. FAU - Kosztin, Annamaria AU - Kosztin A AD - Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary. FAU - Vamos, Mate AU - Vamos M AD - University Hospital Frankfurt-Goethe University, Frankfurt am Main, Germany. AD - Medical Centre-Hungarian Defence Forces, Budapest, Hungary. FAU - Aradi, Daniel AU - Aradi D AD - Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary. AD - Heart Center, Balatonfured, Hungary. FAU - Schwertner, Walter Richard AU - Schwertner WR AD - Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary. FAU - Kovacs, Attila AU - Kovacs A AD - Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary. FAU - Nagy, Klaudia Vivien AU - Nagy KV AD - Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary. FAU - Zima, Endre AU - Zima E AD - Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary. FAU - Geller, Laszlo AU - Geller L AD - Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary. FAU - Duray, Gabor Zoltan AU - Duray GZ AD - Medical Centre-Hungarian Defence Forces, Budapest, Hungary. FAU - Kutyifa, Valentina AU - Kutyifa V AD - Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary. AD - University of Rochester, Medical Center, Rochester, NY, USA. FAU - Merkely, Bela AU - Merkely B AUID- ORCID: 0000-0001-6514-0723 AD - Heart and Vascular Center, Semmelweis University, 68 Varosmajor Street, Budapest, 1122, Hungary. merkely.bela@kardio.sote.hu. LA - eng GR - NVKP_16-1-2016-0017/National Research, Development and Innovation Office/International PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Systematic Review PL - United States TA - Heart Fail Rev JT - Heart failure reviews JID - 9612481 SB - IM MH - Cardiac Resynchronization Therapy/*methods MH - Heart Failure/physiopathology/*therapy MH - Humans MH - Treatment Outcome MH - Ventricular Function, Left/*physiology PMC - PMC5756552 OTO - NOTNLM OT - CRT upgrade OT - Cardiac resynchronization therapy OT - De novo CRT OT - Heart failure OT - Meta-analyses OT - Mortality COIS- 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. EDAT- 2017/10/20 06:00 MHDA- 2019/01/05 06:00 PMCR- 2017/10/19 CRDT- 2017/10/20 06:00 PHST- 2017/10/20 06:00 [pubmed] PHST- 2019/01/05 06:00 [medline] PHST- 2017/10/20 06:00 [entrez] PHST- 2017/10/19 00:00 [pmc-release] AID - 10.1007/s10741-017-9652-1 [pii] AID - 9652 [pii] AID - 10.1007/s10741-017-9652-1 [doi] PST - ppublish SO - Heart Fail Rev. 2018 Jan;23(1):15-26. doi: 10.1007/s10741-017-9652-1.