A systematic review and meta-analysis of upgrade to biventricular or conduction system pacing approaches

Abstract Introduction Chronic RV pacing has been recognised as being harmful to cardiac function. Patients undergoing a de novo pacemaker implant with even mild LV impairment are recommended instead receive physiological strategy (biventricular or conduction system [CSP]). No corresponding guideline recommendation exists for patients who already have pacemaker. Methods We undertook random-effects meta-analysis of all RCTs and observational studies covering device upgrade biventricular pacing. Results 6 assessing effect BiV randomising 161 were eligible analysis. Eligible included 46 7 CSP totalling 2795 patients. Mean LVEF improved by +8.3% from 34.4% in (p=0.001) 25.7% (p<0.001). In CSP, increased +10.1% 38.4% despite less severe at baseline (p=0.004 vs mean EF p<0.0001 studies). LVESV decreased significantly −25.4 ml, −23.7 −19.8 ml RCTs, studies. Significant changes also seen NYHA class (decreased −0.4, −0.8 −1.0 respectively). Minnesota Heart Failure Score (−6.9 points) peak oxygen uptake (+1.1 ml/kg/min) upgrade. This was (−21.0 points +2.63 ml/kg/min Conclusions show significant symptomatic benefit. Observational similar benefit improvements LVEF, an milder degree impairment. Funding Acknowledgement Type funding sources: None.