The Risk of New-Onset Atrial Fibrillation in Patients With Conduction System Pacing Versus Right Ventricular Pacing: A Meta-Analysis.

BACKGROUND

Prior studies have established the safety and efficacy of conduction system pacing (CSP) in improving echocardiographic parameters and clinical outcomes. This meta-analysis aimed to investigate whether CSP could reduce the occurrence of new-onset atrial fibrillation (AF) in comparison to traditional right ventricular pacing (RVP) therapy.

METHODS

A literature search was performed in PubMed, Embase, and the Cochrane Library to identify relevant clinical studies comparing CSP with RVP from January 2000 to June 2024. The study outcome was new-onset AF after pacemaker implantation. Estimated risk ratios (RR), odds ratio (OR) with 95% confidence intervals (CI) were evaluated.

RESULTS

Our analysis included 8 observational studies comprising a total of 2033 patients. The results indicated that 20% (406/2033) of study patients experienced new-onset AF, and CSP was associated with a significantly lower risk of new-onset AF when compared with RVP (RR: 0.44, 95% CI: 0.36-0.54, p < 0.00001, I2 = 11%; OR: 0.34, 95% CI: 0.27-0.44, p < 0.0001, I2 = 0). In the subgroup analysis, patients with atrioventricular block (AVB) tended to benefit more from CSP than those with sinus node dysfunction (SND) or AVB (p = 0.06 for RR; p = 0.12 for OR). Publication bias was observed and confirmed by the Egger's test (p = 0.0125 for RR and 0.0345 for OR). Trim and fill analysis was performed, and the overall summary effect size (RR: 0.51, 95% CI: 0.40-0.64; OR: 0.40, 95% CI: 0.31-0.52) remained significant after adjusting for publication bias.

CONCLUSION

CSP could reduce the occurrence of new-onset AF compared with RVP, and this benefit appeared to be more pronounced in patients with AVB than those with SND or AVB. However, large scale randomized controlled trials are needed to validate our findings.

THE PROSPERO REGISTRATION: Registration number: CRD42024569052; registration date: July 25, 2024; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024569052.