Trial reportEuropean heart journal2023
Upgrade of right ventricular pacing to cardiac resynchronization therapy in heart failure: a randomized trial.
Trial report in European heart journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06241651 (Conduction System Pacing Versus Biventricular Pacing for Heart Failure Patients With Right Ventricular Pacing Upgraded to Cardiac Resynchronization Therapy), which is not on this map. Cited by 49 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Conduction System Pacing Versus Biventricular Pacing for Heart Failure Patients With Right Ventricular Pacing Upgraded to Cardiac Resynchronization Therapy: a Prospective Multicenter Non-inferiority Randomized Controlled Study
Who cites it
49 citing papers in PubMed, 2 syntheses or guidelines pooled it, 70 citations in OpenAlex.
- Evaluating the predictive value of late gadolinium enhancement assessed by cardiac magnetic resonance on sudden cardiac death in patients selected for implantable cardioverter defibrillator and cardiac resynchronization therapy implantation: a systematic review and meta-analysis.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Pooled it
- Time-trend treatment effect of cardiac resynchronization therapy with or without defibrillator on mortality: a systematic review and meta-analysis.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Pooled it
- Benefits of upgrading right ventricular to biventricular pacing in heart failure patients with atrial fibrillation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Trial
- Cardiac implantable electronic devices in heart failure: needs, challenges, and real-world implementation.Heart failure reviews · 2026Review
- Predictors of echocardiographic response in the Budapest-CRT upgrade trial.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- QRS Area Before and After Upgrading to Cardiac Resynchronization Therapy Is Not Sufficient to Predict Outcome.Journal of cardiovascular development and disease · 2026Article
- Cardiac remodelling and functional status after cardiac resynchronization therapy: comparison between de-novo implantation and upgrade from right ventricular pacing.ESC heart failure · 2026Article
- CRT upgrade improves frailty status in patients with HFrEF and RV pacing-a post hoc analysis of the BUDAPEST-CRT trial.GeroScience · 2026Article
- Long-Term Outcomes of Radiofrequency Atrioventricular Node Ablation in a Real-World Population.Pacing and clinical electrophysiology : PACE · 2026Observational
- Cardiac Resynchronization Therapy: A Review.JAMA · 2026Review
- Impact of generator replacement and other device procedures on timing of implantable cardioverter-defibrillator lead removal.Scientific reports · 2026Article
- Deterioration of Cardiac Function Complicated by Ventricular Tachycardia After the Implantation of an Artificial Cardiac Pacemaker and Upgrading to CRT-D: One Case Report.Clinical case reports · 2026Article
- Left Ventricular Global Longitudinal Strain Predicts Pacemaker-Associated Cardiomyopathy with Substantial LVEF Deterioration: Results from a Single-Center Cohort Study in Germany.Journal of clinical medicine · 2026Article
- Long Term Outcomes and Predictors of Reverse Remodelling After Cardiac Resynchronization Therapy Upgrade.Medicina (Kaunas, Lithuania) · 2026Article
- 'Ablate and pace' reduces mortality in heart failure patients with atrial fibrillation: an updated meta-analysis.European heart journal open · 2026Article
- Conventional cardiac resynchronization therapy upgrading and its effect on functional mitral regurgitation in patients with pacing-induced cardiomyopathy.Frontiers in cardiovascular medicine · 2026Article
- Long-term outcomes of upgrading to cardiac resynchronization therapy in patients with left bundle branch block or right ventricular pacing.Heart rhythm O2 · 2025Article
- Cardiac implantable electronic device upgrades and downgrades: a Clinical Consensus Statement of the European Heart Rhythm Association (EHRA) of the ESC, the Asia Pacific Heart Rhythm Association (APHRS), Canadian Heart Rhythm Society (CHRS), Heart Rhythm Society (HRS), and the Latin American Heart Rhythm Society (LAHRS).Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Article
- Markers of sudden cardiac death associated with the ventricular-paced 12-lead ECG.European heart journal open · 2025Article
- Comparing Conduction System Pacing to Biventricular Upgrade in Pacemaker-Induced Cardiomyopathy: A Retrospective Observational Study.Journal of clinical medicine · 2025Article
Corrections and comments
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Authors and funding
21 authors at 8 institutions in 6 countries.
Funding
Abstract
BACKGROUND AND
aimsDe novo implanted cardiac resynchronization therapy with defibrillator (CRT-D) reduces the risk of morbidity and mortality in patients with left bundle branch block, heart failure and reduced ejection fraction (HFrEF). However, among HFrEF patients with right ventricular pacing (RVP), the efficacy of CRT-D upgrade is uncertain.
methodsIn this multicentre, randomized, controlled trial, 360 symptomatic (New York Heart Association Classes II-IVa) HFrEF patients with a pacemaker or implantable cardioverter defibrillator (ICD), high RVP burden ≥ 20%, and a wide paced QRS complex duration ≥ 150 ms were randomly assigned to receive CRT-D upgrade (n = 215) or ICD (n = 145) in a 3:2 ratio. The primary outcome was the composite of all-cause mortality, heart failure hospitalization, or <15% reduction of left ventricular end-systolic volume assessed at 12 months. Secondary outcomes included all-cause mortality or heart failure hospitalization.
resultsOver a median follow-up of 12.4 months, the primary outcome occurred in 58/179 (32.4%) in the CRT-D arm vs. 101/128 (78.9%) in the ICD arm (odds ratio 0.11; 95% confidence interval 0.06-0.19; P < .001). All-cause mortality or heart failure hospitalization occurred in 22/215 (10%) in the CRT-D arm vs. 46/145 (32%) in the ICD arm (hazard ratio 0.27; 95% confidence interval 0.16-0.47; P < .001). The incidence of procedure- or device-related complications was similar between the two arms [CRT-D group 25/211 (12.3%) vs. ICD group 11/142 (7.8%)].
conclusionsIn 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.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.