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The therapeutic effects of upgrade to cardiac resynchronization therapy in pacing-induced cardiomyopathy or chronic right ventricular pacing patients: a meta-analysis

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Abstract

Pacing-induced cardiomyopathy (PICM) or heart failure accompanied with chronic right ventricular pacing (CRVP-HF) has no established treatments. We aimed to carry out a meta-analysis of published studies about the therapeutic effects of the upgrade to cardiac resynchronization therapy (CRT) in patients of PICM/CRVP-HF. The PUBMED, EMBASE, MEDLINE, OVID databases, and Cochrane Library were systemically searched for relevant publications. Data about the improvements of left ventricular ejection fraction (LVEF), NYHA functional class (NYHA-FC), and the CRT response rate was extracted and synthesized. Mean difference (MD), odds ratio, and standard mean difference (SMD) with 95% confidence interval (CI) were calculated as the effect size by both fixed and random effect models. We included sixteen studies (four about PICM and twelve about CRVP-HF). The total sample size of PICM/CRVP-HF patients was 924. Upgrade to CRT improved the LVEF by 10.87% (95%CI, 8.90 to 12.84%) and reduce the NYHA-FC by around one class (MD, −1.25; 95%CI, −1.43 to −1.06) in PICM/CRVP-HF patients overall. Upgrade to CRT seemed to improve LVEF no less than de-novo CRT (SMD 0.24; 95%CI 0.05 to 0.43; P < 0.05). This meta-analysis suggested that upgrade CRT could improve the cardiac function in PICM/CRVP-HF patients. This strategy may be considered in these patients but require more evidence about the efficacy and procedure-related complications from prospective studies or randomized controlled trials.

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Authors and Affiliations

  1. State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 167, Beilishi Road, ** Chen & Shu Zhang

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  1. Wenzhao Lu
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  2. **xuan Lin
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  3. Yan Dai
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  4. Ke** Chen
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  5. Shu Zhang
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Contributions

Author Wenzhao Lu and Ke** Chen came up with the conception and design of the study. Data collection was completed by Wenzhao Lu and **xuan Lin. Data analysis was performed by Wenzhao Lu, and the result interpretation was done by Wenzhao Lu and **xuan Lin. All the authors participated in drafting and revising the article. The final approval of the version to be submitted was performed by Yan Dai, Ke** Chen, and Shu Zhang.

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Correspondence to Ke** Chen.

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Lu, W., Lin, J., Dai, Y. et al. The therapeutic effects of upgrade to cardiac resynchronization therapy in pacing-induced cardiomyopathy or chronic right ventricular pacing patients: a meta-analysis. Heart Fail Rev 27, 507–516 (2022). https://doi.org/10.1007/s10741-021-10091-z

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