Related Experiment Video
Updated: May 6, 2026
Optimization of Transesophageal Atrial Pacing to Assess Atrial Fibrillation Susceptibility in Mice
Published on: June 29, 2022
Cardiovascular outcomes with atrial-based pacing compared with ventricular pacing: meta-analysis of randomized
Jeffrey S Healey1, William D Toff, Gervasio A Lamas
1Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada, L8L 2X2. healeyj@hhsc.ca
Insights
Atrial-based pacing does not improve survival or reduce heart failure in patients with bradycardia. However, it significantly reduces atrial fibrillation and may modestly lower stroke risk.
Area of Science:
- Cardiology
- Electrophysiology
- Clinical Trials
Background:
- Randomized trials have compared atrial-based pacing with ventricular pacing for bradycardia.
- Previous studies have not demonstrated mortality reduction with atrial-based pacing.
- The goal was to assess if atrial-based pacing prevents major cardiovascular events.
Purpose of the Study:
- To systematically review randomized trials comparing atrial-based pacing (ABP) versus ventricular pacing (VP).
- To determine the effect of ABP on major cardiovascular events, including mortality, stroke, heart failure, and atrial fibrillation.
Main Methods:
- Systematic review of publications since 1980.
- Inclusion criteria: randomized controlled trials comparing ABP vs. VP with data on mortality, stroke, heart failure, or atrial fibrillation.
- Individual patient data from 5 of 8 identified trials (35,000 patient-years) were analyzed.
Main Results:
- No significant reduction in mortality (HR 0.95) or heart failure (HR 0.89) with ABP.
- Significant reduction in atrial fibrillation (HR 0.80) with ABP.
- Borderline significant reduction in stroke (HR 0.81) with ABP.
Conclusions:
- Atrial-based pacing does not improve survival or reduce heart failure or cardiovascular death compared to ventricular pacing.
- Atrial-based pacing significantly reduces the incidence of atrial fibrillation.
- Atrial-based pacing may offer a modest reduction in stroke risk.
Background:
Several randomized trials have compared atrial-based (dual-chamber or atrial) pacing with ventricular pacing in patients with bradycardia. No trial has shown a mortality reduction, and only 1 small trial suggested a reduction in stroke. The goal of this review was to determine whether atrial-based pacing prevents major cardiovascular events.
Methods And Results:
A systematic review was performed of publications since 1980. For inclusion, trials had to compare an atrial-based with a ventricular-based pacing mode; use a randomized, controlled, parallel design; and have data on mortality, stroke, heart failure, or atrial fibrillation. Individual patient data were obtained from 5 of the 8 identified studies, representing 95% of patients in the 8 trials, and a total of 35 000 patient-years of follow-up. There was no significant heterogeneity among the results of the individual trials. There was no significant reduction in mortality (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.87 to 1.03; P=0.19) or heart failure (HR, 0.89; 95% CI, 0.77 to 1.03; P=0.15) with atrial-based pacing. There was a significant reduction in atrial fibrillation (HR, 0.80; 95% CI, 0.72 to 0.89; P=0.00003) and a reduction in stroke that was of borderline significance (HR, 0.81; 95% CI, 0.67 to 0.99; P=0.035). There was no convincing evidence that any patient subgroup received special benefit from atrial-based pacing.
Conclusions:
Compared with ventricular pacing, the use of atrial-based pacing does not improve survival or reduce heart failure or cardiovascular death. However, atrial-based pacing reduces the incidence of atrial fibrillation and may modestly reduce stroke.
