Feng Li, You Zhang, Jian Huang, Si-Liang Peng, Meng-Chao Jin, Chi Geng, Venkatesh Ravi, Parikshit S Sharma, Pugazhendhi Vijayaraman, Hui Li
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The pooled risk of new-onset AF based on ventricular pacing burden (Vp) between CSP and RVP group were evaluated.</p><p><strong>Results: </strong>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%.</p><p><strong>Conclusions: </strong>Our study suggests that CSP is associate with a significantly lower occurrence of new-onset AF compared with RVP. 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引用次数: 0
摘要
背景：与右心室起搏（RVP）相比，传导系统起搏（CSP）已被报道可以改善临床结果。然而，CSP和RVP对新发心房颤动（AF）风险的影响尚不明确。方法：系统检索截至2024年7月1日的4个在线数据库。包括CSP组和RVP组之间新发房颤发生率/风险的研究。进行亚组分析以筛选CSP治疗新发房颤风险的潜在决定因素。评估CSP组和RVP组基于心室起搏负荷（Vp）的新发房颤合并风险。结果：共有6项研究包括1577例需要起搏治疗的患者符合条件。CSP组和RVP组的合并新发房颤发生率分别为0.09和0.27。与RVP组相比，CSP组新发房颤的合并风险（风险比[RR] 0.38, p = 0.000）和校正风险（风险比[HR] 0.32, p = 0.000）较低，且在Vp < 20%和Vp≥20%时，CSP组与RVP组新发房颤校正风险存在显著的干预协变量交互作用。结论：我们的研究表明，与RVP相比，CSP与新发房颤的发生率显著降低有关。血压≥20%可能是CSP治疗降低新发房颤风险的关键决定因素。试验注册：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023492551，标识符（CRD42023492551）。
Lower Risk of New-Onset Atrial Fibrillation in Conduction System Pacing Compared With Right Ventricular Pacing.
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.
期刊介绍：
Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.
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