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Lower Risk of New-Onset Atrial Fibrillation in Conduction System Pacing Compared With Right Ventricular Pacing
Feng Li1, You Zhang1, Jian Huang1
1Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Insights
Conduction system pacing (CSP) significantly reduces new-onset atrial fibrillation (AF) compared to right ventricular pacing (RVP). Ventricular pacing burden of 20% or more may be key to CSP
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Conduction system pacing (CSP) shows promise for improving patient outcomes over traditional right ventricular pacing (RVP).
- The comparative impact of CSP versus RVP on the incidence of new-onset atrial fibrillation (AF) requires further elucidation.
- Atrial fibrillation is a common complication following cardiac pacing procedures.
Purpose of the Study:
- To systematically evaluate the risk of new-onset atrial fibrillation (AF) associated with conduction system pacing (CSP) compared to right ventricular pacing (RVP).
- To identify potential factors influencing the risk of new-onset AF in patients undergoing CSP.
Main Methods:
- A systematic literature search was conducted across four databases up to July 1, 2024.
- Included studies compared the incidence or risk of new-onset AF between CSP and RVP groups.
- Subgroup analyses and pooled risk assessments, considering ventricular pacing burden (Vp), were performed.
Main Results:
- Six studies involving 1577 patients were analyzed.
- The pooled incidence of new-onset AF was 0.09 for CSP and 0.27 for RVP.
- CSP demonstrated a significantly lower pooled risk (RR 0.38) and adjusted risk (HR 0.32) of new-onset AF compared to RVP, particularly when Vp was ≥ 20%.
Conclusions:
- Conduction system pacing is associated with a substantially reduced risk of new-onset atrial fibrillation when compared to right ventricular pacing.
- A ventricular pacing burden of 20% or greater appears to be a critical factor in achieving the lower AF risk observed with CSP therapy.
Background:
Conduction system pacing (CSP) has been reported to improve clinical outcomes in comparison of right ventricular pacing (RVP). However, the performance between CSP and RVP on the risk of new-onset atrial fibrillation (AF) remains elusive.
Methods:
Four online databases were systematically searched up to July 1, 2024. Studies comprising the rate/risk of new-onset AF between CSP and RVP group were included. Subgroup analysis was performed to screen the potential determinants for the new-onset AF risk for CSP therapy. The pooled risk of new-onset AF based on ventricular pacing burden (Vp) between CSP and RVP group were evaluated.
Results:
A total of six studies including 1577 patients requiring pacing therapy were eligible. The pooled new-onset AF rates for CSP and RVP group were 0.09 and 0.27, respectively. Compared with RVP group, CSP group showed a lower pooled risk (risk ratio [RR] 0.38, p = 0.000) and adjusted risk (hazard ratio [HR] 0.32, p = 0.000) of new-onset AF. Meanwhile, a significant intervention-covariate interaction for the adjusted risk of new-onset AF between CSP and RVP group was identified with Vp < 20% and Vp ≥ 20%.
Conclusions:
Our study suggests that CSP is associate with a significantly lower occurrence of new-onset AF compared with RVP. The Vp ≥ 20% may be the key determinant on the lower risk of new-onset AF with CSP therapy.
Trial Registration:
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023492551, identifier (CRD42023492551).
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