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Meta-Analysis
. 2025 Feb;48(2):202-215.
doi: 10.1111/pace.15121. Epub 2025 Jan 15.

Lower Risk of New-Onset Atrial Fibrillation in Conduction System Pacing Compared With Right Ventricular Pacing

Feng Li  1 , You Zhang  1 , Jian Huang  1 , Si-Liang Peng  1 , Meng-Chao Jin  1 , Chi Geng  1 , Venkatesh Ravi  2 , Parikshit S Sharma  2 , Pugazhendhi Vijayaraman  3 , Hui Li  1
Affiliations
Meta-Analysis

Lower Risk of New-Onset Atrial Fibrillation in Conduction System Pacing Compared With Right Ventricular Pacing

Feng Li et al. Pacing Clin Electrophysiol. 2025 Feb.

Abstract

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).

Keywords: His bundle pacing; conduction system pacing; left bundle branch area pacing; new‐onset atrial fibrillation; right ventricular pacing.

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References

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