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).
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.
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.