Heart failure & cardiomyopathiesRandomised controlled trial
Upgrade of right ventricular pacing to cardiac resynchronization therapy in heart failure: a randomized trial
- Randomised controlled trial
- multicentre
- 3:2 randomisation
Authors' conclusion
In pacemaker or ICD patients with significant RVP burden and reduced ejection fraction, upgrade to CRT-D compared with ICD therapy reduced the combined risk of all-cause mortality, heart failure hospitalization, or absence of reverse remodelling.
Study context
- Population
- Symptomatic (NYHA II-IVa) heart failure and reduced ejection fraction (HFrEF) patients with a pacemaker or implantable cardioverter defibrillator (ICD), RV pacing burden ≥ 20% and paced QRS ≥ 150 ms
- Participants
- 360 participants
- Comparison
- Cardiac resynchronization therapy with defibrillator (CRT-D) upgrade vs ICD
- CRT-Dn = 215
- ICDn = 145reference
- Primary endpoint
- All-cause mortality, HF hospitalization, or <15% reduction of LV end-systolic volume
- Follow-up
- 12 months
Primary result
As reported in the abstract
Odds ratio
0.11
95% CI 0.06–0.19
P < 0.001
Events by treatment group
CRT-D vs ICD
OR 0.11 (95% CI 0.06–0.19); P < 0.001
Secondary outcomes
| Outcome | CRT-D | ICD | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| All-cause mortality or HF hospitalization | 10% | 32% | 0.27 (0.16–0.47) | P < 0.001 | |
| 0.10.31310Hazard ratio (log scale) |
Safety
Procedure- or device-related complications
denominator CRT-D 211 · ICD 142
Procedure- or device-related complications
- Similar between the two arms
Original publication
Upgrade of right ventricular pacing to cardiac resynchronization therapy in heart failure: a randomized trial. Eur Heart J. Published 26 August 2023. doi:10.1093/eurheartj/ehad591
Summarised from the published abstract; every number is checked against it