title: Meta-analysis of randomized controlled trials evaluating left ventricular vs. biventricular pacing in heart failure: effect on all-cause mortality and hospitalizations.
abstract: OBJECTIVE
  Randomized controlled trials (RCTs) showed that biventricular (BiV) pacing reduces heart failure (HF) hospitalizations and mortality in patients with New York Heart Association (NYHA) class III-IV HF, left ventricular (LV) dysfunction, and wide QRS. We performed a systematic review and meta-analysis of the RCTs comparing LV-only vs. biventricular (BiV) pacing in candidates for cardiac resynchronization therapy (CRT).
  
  
  RESULTS
  The systematic review selected five RCTs (out of 1888 analysed reports) with a cumulative number of 372 patients randomized to BiV pacing and 258 to LV-only pacing. The meta-analysis shows that BiV pacing is not superior to LV-only pacing and that these two pacing modalities do not differ with regard to death or heart transplantation [LV-only vs. BiV pacing odds ratio (OR) 1.24, 95% confidence interval (CI) 0.57-2.70 with the fixed effect model, OR 1.25, 95% CI 0.48-3.24 with the random effect model]. Specific data on hospitalizations were available only in two RCTs with a cumulative number of 127 patients randomized to BiV and 123 to LV-only pacing. The meta-analysis shows that BiV pacing is not superior to LV-only pacing and that these two pacing modalities do not differ with regard to this outcome (LV-only vs. BiV pacing OR 0.86, 95% CI 0.49-1.50 with the fixed effect model, OR 0.86, 95% CI 0.49-1.50 with the random effect model).
  
  
  CONCLUSIONS
  Biventricular pacing is not superior to LV-only pacing, and these two pacing modalities appear to achieve similar efficacy in candidates for CRT for moderate to severe HF, in terms of all-cause mortality and hospitalizations during follow-up.
authors.affiliation: Institute of Cardiology, University of Bologna, Bologna, Italy. giuseppe.boriani@unibo.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: Beatrice
authors.initials: B
authors.lastname: Gardini
authors.forename: Igor
authors.initials: I
authors.lastname: Diemberger
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Bacchi Reggiani
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.forename: Cristian
authors.initials: C
authors.lastname: Martignani
authors.forename: Matteo
authors.initials: M
authors.lastname: Ziacchi
authors.forename: Cinzia
authors.initials: C
authors.lastname: Valzania
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gasparini
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
mesh_terms: D058406:Cardiac Resynchronization Therapy; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D016017:Odds Ratio; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left