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

IF 1.9 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Reviews in cardiovascular medicine Pub Date : 2025-04-18 eCollection Date: 2025-04-01 DOI:10.31083/RCM27921

Tingwen Gao, Zhaofeng Li, Wei Li, Xue Wang, Xinxing Xie

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引用次数: 0

Abstract

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.

查看原文本刊更多论文

传导系统起搏与右心室起搏患者新发心房颤动的风险：一项荟萃分析

背景：先前的研究已经证实了传导系统起搏（CSP）在改善超声心动图参数和临床结果方面的安全性和有效性。本荟萃分析旨在探讨与传统的右心室起搏（RVP）治疗相比，CSP是否可以减少新发心房颤动（AF）的发生。方法：检索PubMed、Embase和Cochrane图书馆2000年1月至2024年6月期间比较CSP和RVP的相关临床研究。研究结果为起搏器植入后新发房颤。评估估计风险比（RR）、优势比（OR）和95%置信区间（CI）。结果：我们的分析包括8项观察性研究，共2033例患者。结果显示，20%（406/2033）的研究患者发生新发房颤，与RVP相比，CSP与新发房颤的风险显著降低相关(RR: 0.44, 95% CI: 0.36-0.54, p < 0.00001, I2 = 11%；或:0.34,95%置信区间CI: 0.27 - -0.44, p < 0.0001, I2 = 0)。在亚组分析中，房室传导阻滞（AVB）患者比窦房结功能障碍（SND）或AVB患者更倾向于从CSP中获益(RR = 0.06；OR = 0.12)。通过Egger检验观察并证实发表偏倚（RR = 0.0125, OR = 0.0345）。进行修剪和填充分析，总体总结效应大小(RR: 0.51, 95% CI: 0.40-0.64；OR: 0.40, 95% CI: 0.31-0.52)在校正发表偏倚后仍然显著。结论：与RVP相比，CSP可以减少新发房颤的发生，并且这种益处在AVB患者中比SND或AVB患者更为明显。然而，需要大规模的随机对照试验来验证我们的发现。本次普洛斯彼罗注册：注册号：CRD42024569052；报名日期：2024年7月25日；https://www.crd.york.ac.uk/PROSPERO/view/CRD42024569052。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Reviews in cardiovascular medicine 医学-心血管系统

CiteScore

2.70

自引率

3.70%

发文量

377

审稿时长

1 months

期刊介绍： RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.