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目的:分析真实世界中常规起搏器升级为心脏再同步治疗（CRT）的临床疗效，探讨影响CRT升级疗效的预测因素。方法:回顾性收集中国医学科学院阜外医院2008年5月至2020年2月常规起搏器升级为CRT患者的临床资料，将其分为起搏器诱导性心肌病（PICM）组和非PICM组，CRT升级术后进行随访，分析CRT升级的临床疗效及其预测因素。结果:研究纳入56例CRT升级患者，年龄为（58.8±11.6）岁，男42例（75.0%，42/56）。CRT升级前34例（60.7%，34/56）患者为PICM，22例（39.3%，22/56）患者为非PICM。非PICM患者较PICM患者左心房内径及左心室舒张末期内径显著增大，左心室射血分数显著减低（12.0%±9.3%对5.4%±9.6%，n P=0.012），合并肺动脉高压及肾功能不全比例更高。随访6个月，共有40例（71.4%，40/56）患者为CRT有反应。PICM组患者CRT有反应率明显高于非PICM组[85.3%（29/34）对50.0%（11/22），n P=0.007]。多因素Logistic回归分析显示PICM是CRT升级有反应的独立预测因素。n 结论:常规起搏器升级为CRT后疗效总体较好，PICM患者CRT有反应率更高，CRT升级后心脏结构及心功能改善更明显，对于诊断明确的PICM患者建议尽早升级CRT。“,”Objective:To analyze and investigate the efficacy and its predictive factors in patients upgraded from conventional pacing to cardiac resynchronization therapy (CRT) in the real world.Methods:The study included 56 consecutive patients who underwent CRT upgrading at Fuwai Hospital from May 2008 to February 2020. The patients were classified to right ventricular pacingn -induced cardiomyopathy (PICM) group and no PICM group at baseline. The CRT response and its predictive factors were analyzed in patients who underwent CRT upgrading.n Results:The mean age of patients was (58.8±11.6) years, and 42 patients (75.0%, 42/56) were male. Thirtyn -four patients (60.7%, 34/56) were PICM, and the remaining 22 patients (39.3%, 22/56) were no PICM. Compared with patients with PICM, patients with no PICM had larger left atrial dimension and left ventricular endn -diastolic dimension, and lower left ventricular ejection fraction [ (12.0%±9.3%) vs. (5.4%±9.6%) , n P=0.012] as well as higher proportion of pulmonary hypertension and renal malfunction. During a mean follown -up of 6 months, 40 patients (71.4%, 40/56) presented CRT response. The CRT response rate was significant higher in PICM group[85.3% (29/34) vs. 50.0% (11/22, n P=0.007]. In a multivariable Logistic model, the CRT response was strongly associated with PICM.n Conclusion:The clinical prognosis of patients who underwent CRT upgrading was favorable. The CRT response rate was significantly higher in PICM group and cardiac remodeling reversal of PICM following CRT upgrading was greater. The PICM patients could be considered initially to upgrade CRT as soon as possible.