Interatrial septal pacing to suppress atrial fibrillation in patients with dual chamber pacemakers: A meta-analysis of randomized, controlled trials

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• 作者：Shalaimaiti Shali¹ ; ^{shali@zs-hospital.sh.cn" class="auth_mail" title="E-mail the corresponding author} ; Yangang Su¹ ; Junbo Ge ; ¹ ; ^{jbge@zs-hospital.sh.cn" class="auth_mail" title="E-mail the corresponding author}
• 关键词：AF ; atrial fibrillation ; SSS ; sick sinus syndrome ; AVB ; atrioventricular block ; AP ; atrial pacing ; VP ; ventricular pacing ; RAA ; right atrium appendage ; HRA ; high right atrium ; IACD ; interatrial conduction delay ; PWD ; P wave duration ; AVI ; atrioventricular interval ; HR ; hazard ratio ; OR ; odds ratio ; SMD ; standard mean difference ; CIs ; confidence intervals ; RCT ; randomized clinical trial ; MAE ; major adverse event
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 September 2016
• 年：2016
• 卷：219
• 期：Complete
• 页码：421-427
• 全文大小：1218 K

文摘

Atrial fibrillation (AF) is of frequent occurrence in a population with bradycardia indicated for permanent dual chamber pacing. Whether selective site pacing at interatrial septum (IAS) could better prevent AF as compared with standard atrial pacing (AP) from right atrial appendage or high right atrium in these conditions remains in question. Its safety profile has yet to be elucidated.

Methods

Major web databases were searched up to February 2015 for controlled, randomized clinical trials on IAS versus conventional pacing. The primary end point was freedom from persistent/permanent AF. Secondary outcomes included device-recorded AF burden and frequency of AF episodes, lead-related complications, and major adverse events (MAEs).

Results

We identified 10 eligible studies incorporating a total of 1245 patients. Compared to conventional AP, IAS pacing conferred no additional benefit on the persistent/permanent AF free survival (hazard ratio 0.76, 95% confidence interval [CI] 0.48 to 1.22); it was associated with notably reduced device-detected AF burden (standard mean difference [SMD] − 0.32, 95% CI − 0.55 to − 0.09) and AF frequency (SMD − 0.54, 95% CI − 0.83 to − 0.24). The odds of lead-related complications (odds ratio [OR] 1.64, 95% CI 0.87 to 3.08) and combined rate of MAEs (OR 1.05, 95% CI 0.60 to 1.82) were similar between two groups.

Conclusions

IAS pacing has no influence on the persistent/permanent AF progression and MAEs, although it appears to lower device-detected AF burden and AF frequency, and may carry similar risks of lead-related complications as compared to standard AP.