Heart failure & cardiomyopathiesMeta-analysis
Cardiac remodelling and functional status after cardiac resynchronization therapy: comparison between de-novo implantation and upgrade from right ventricular pacing
- Pooled analysis of patients from the ImagingCRT, ElectroCRT and DANISH-CRT trials
Authors' conclusion
Patients with RV paced QRS morphology who are upgraded to CRT derive substantial improvement in cardiac function and functional capacity, comparable to patients with intrinsic conduction undergoing CRT.
Study context
- Population
- Patients aged ≥40 years with left ventricular ejection fraction (LVEF) ≤35% and prolonged QRS undergoing cardiac resynchronization therapy (CRT)mean age 70.7 ± 9 years, 24.8% women, mean LVEF 27 ± 6%
- Participants
- 592 patients
- Comparison
- patients with right ventricular (RV) pacing and intrinsic conduction at baseline
- RV pacingn = 97
- intrinsic conductionn = 495
- Outcome
- Change in left ventricular end-systolic volume (LVESV) (relative reduction)
- Follow-up
- baseline to 6-month follow-up
Pooled result
As reported in the abstract
Mean difference
−2% %
95% CI −8 to 4
P = 0.469
By group
RV pacing
−34
mean · SD 25 · %
intrinsic conduction
−32
mean · SD 26 · %
RV pacing vs intrinsic conduction
mean difference −2% % (95% CI −8 to 4); P = 0.469
Further pooled results
Absolute LVEF improvement
ms
| Outcome | RV pacing | intrinsic conduction |
|---|---|---|
| Reduction in QRS duration | −38 (SD 26) | −26 (SD 24) |
Reduction in QRS duration
- Reduction in QRS duration was larger with RV pacing compared with intrinsic conduction
Remaining secondary endpoints
- significant improvements in the remaining secondary endpoints, with no difference between the groups
Original publication
Cardiac remodelling and functional status after cardiac resynchronization therapy: comparison between de-novo implantation and upgrade from right ventricular pacing. ESC Heart Fail. Published 26 June 2026. doi:10.1093/eschf/xvag183
Summarised from the published abstract; every number is checked against it