Cardiac Resynchronization Therapy Upgrade in Patients with Chronic Right Ventricular Pacing: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cardiac Resynchronization Therapy Upgrade in Patients with Chronic Right Ventricular Pacing: A Systematic Review and Meta-Analysis of Randomized Controlled Trials | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 1 October 2025 V1 Latest version Share on Cardiac Resynchronization Therapy Upgrade in Patients with Chronic Right Ventricular Pacing: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Authors : Faizan Abbas 0009-0005-5176-1680 [email protected] , Abdullah Safdar , Johar Raza , Fatima Akram , Minahil Saleem , Hazem Abozguiya , Muhammad Hamza Rana , … Show All … , Hamama Waseem , Muhammad Subhan Saleem , Izma Kamran Ali , Waila Mirza , Saad Ahmed Waqas 0009-0008-9051-6081 , and Khalid Abozguiya Show Fewer Authors Info & Affiliations https://doi.org/10.22541/au.175932740.00114219/v1 204 views 112 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background Pacemaker-induced cardiomyopathy (PICM) is a recognized complication of chronic right ventricular (RV) pacing. While upgrade to cardiac resynchronization therapy (CRT) is a standard treatment, the evidence base is heterogeneous, and the impact on mortality remains uncertain. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing upgrade to CRT versus continued RV pacing in patients with PICM. Primary endpoints were changes in left ventricular ejection fraction (LVEF), end-systolic volume (LVESV), and end-diastolic volume (LVEDV). Secondary endpoints included NT-proBNP, functional status, quality of life (QoL), and all-cause mortality. Data were pooled using a generic inverse-variance random-effects model. Subgroup analysis by trial design (crossover vs. parallel) and extensive sensitivity analyses was also performed. Results Seven randomized controlled trials (N = 594) met inclusion. CRT upgrade increased LVEF by 8.40 percentage points, 95% CI [4.73, 12.07], 95% PI [−0.58, 17.38], p < .001; reduced LVESV by 26.86 mL, 95% CI [−40.99, −12.74], 95% PI [−49.66, −4.07], p < .001; and reduced LVEDV by 23.52 mL, 95% CI [−39.83, −7.20], 95% PI [−52.71, 5.68], p = .005. Significant benefits were also observed for NT-proBNP, New York Heart Association (NYHA) class, and peak VO 2 . Effects were larger and more precise in parallel trials than in crossover trials for LVEF. Prediction intervals crossed the null for most outcomes, indicating setting-level variability in true effects. GRADE certainty was moderate for LVESV and NYHA and low to very low for other outcomes Conclusion In PICM, CRT upgrade improves ventricular remodeling, systolic function, and functional capacity, though certainty varies. Wide prediction intervals indicate context-dependent benefit; further trials should clarify long-term outcomes and optimize patient selection. Supplementary Material File (manuscript.docx) Download 15.94 MB Information & Authors Information Version history V1 Version 1 01 October 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keyword clinical: implantable devices – biventricular pacing/defibrillation Authors Affiliations Faizan Abbas 0009-0005-5176-1680 [email protected] Fatima Memorial Hospital View all articles by this author Abdullah Safdar NYC Health + Hospitals/Harlem View all articles by this author Johar Raza Allama Iqbal Medical College View all articles by this author Fatima Akram Thomas Jefferson University View all articles by this author Minahil Saleem King Edward Medical University View all articles by this author Hazem Abozguiya Marshall University Joan C Edwards School of Medicine View all articles by this author Muhammad Hamza Rana Conemaugh Memorial Medical Center View all articles by this author Hamama Waseem United Medical and Dental College View all articles by this author Muhammad Subhan Saleem Allama Iqbal Medical College View all articles by this author Izma Kamran Ali Dow Medical College View all articles by this author Waila Mirza Dow Medical College View all articles by this author Saad Ahmed Waqas 0009-0008-9051-6081 Dow Medical College View all articles by this author Khalid Abozguiya Marshall University Joan C Edwards School of Medicine View all articles by this author Metrics & Citations Metrics Article Usage 204 views 112 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Faizan Abbas, Abdullah Safdar, Johar Raza, et al. Cardiac Resynchronization Therapy Upgrade in Patients with Chronic Right Ventricular Pacing: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Authorea . 01 October 2025. DOI: https://doi.org/10.22541/au.175932740.00114219/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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