Implication of ventricular pacing burden and atrial pacing therapies on the progression of atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials

Dian A. Munawar, Rajiv Mahajan, Thomas A. Agbaedeng, Anand Thiyagarajah, Darragh J. Twomey, Kashif Khokhar, Catherine O'Shea, Glenn D. Young, Kurt C. Roberts-Thomson, Muhammad Munawar, Dennis H. Lau, Prashanthan Sanders

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Atrial fibrillation (AF) is common after pacemaker implantation. However, the impact of pacemaker algorithms in AF prevention is not well understood. Objective: The purpose of this study was to evaluate the role of pacing algorithms in preventing AF progression. Methods: A systematic search of articles using the PubMed and Embase databases resulted in a total of 754 references. After exclusions, 21 randomized controlled trials (8336 patients) were analyzed, comprising studies reporting ventricular pacing percentage (VP%) (AAI vs DDD, n = 1; reducing ventricular pacing [RedVP] algorithms, n = 2); and atrial pacing therapies (atrial preference pacing [APP], n = 14; atrial antitachycardia pacing [aATP]+APP, n = 3; RedVP+APP+aATP, n = 1). Results: Low VP% (<10%) lead to a nonsignificant reduction in the progression of AF (hazard ratio [HR] 0.80; 95% confidence interval [CI] 0.57–1.13; P =.21; I2 = 67%) compared to high VP% (>10%). APP algorithm reduced premature atrial complexes (PAC) burden (mean difference [MD] –1117.74; 95% CI –1852.36 to –383.11; P =.003; I2 = 67%) but did not decrease AF burden (MD 8.20; 95% CI –5.39 to 21.80; P =.24; I2 = 17%) or AF episodes (MD 0.00; 95% CI –0.24 to 0.25; P =.98; I2 = 0%). Similarly, aATP+APP programming showed no significant difference in AF progression (odds ratio 0.65; 95% CI 0.36–1.14; P =.13; I2 = 61%). No serious adverse events related to algorithm were reported. Conclusion: This meta-analysis of randomized controlled trials demonstrated that algorithms to reduce VP% can be considered safe. Low burden VP% did not significantly suppress AF progression. The atrial pacing therapy algorithms could suppress PAC burden but did not prevent AF progression.

LanguageEnglish
Pages1204-1214
Number of pages11
JournalHeart Rhythm
Volume16
Issue number8
DOIs
Publication statusPublished - 1 Aug 2019

Keywords

  • Arial preference pacing
  • Atrial fibrillation
  • Atrial pacing therapies
  • Minimize ventricular pacing
  • Reduced ventricular pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Munawar, Dian A. ; Mahajan, Rajiv ; Agbaedeng, Thomas A. ; Thiyagarajah, Anand ; Twomey, Darragh J. ; Khokhar, Kashif ; O'Shea, Catherine ; Young, Glenn D. ; Roberts-Thomson, Kurt C. ; Munawar, Muhammad ; Lau, Dennis H. ; Sanders, Prashanthan. / Implication of ventricular pacing burden and atrial pacing therapies on the progression of atrial fibrillation : A systematic review and meta-analysis of randomized controlled trials. In: Heart Rhythm. 2019 ; Vol. 16, No. 8. pp. 1204-1214.
@article{36270eb7a9e2459daa6e629eba4b514e,
title = "Implication of ventricular pacing burden and atrial pacing therapies on the progression of atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials",
abstract = "Background: Atrial fibrillation (AF) is common after pacemaker implantation. However, the impact of pacemaker algorithms in AF prevention is not well understood. Objective: The purpose of this study was to evaluate the role of pacing algorithms in preventing AF progression. Methods: A systematic search of articles using the PubMed and Embase databases resulted in a total of 754 references. After exclusions, 21 randomized controlled trials (8336 patients) were analyzed, comprising studies reporting ventricular pacing percentage (VP{\%}) (AAI vs DDD, n = 1; reducing ventricular pacing [RedVP] algorithms, n = 2); and atrial pacing therapies (atrial preference pacing [APP], n = 14; atrial antitachycardia pacing [aATP]+APP, n = 3; RedVP+APP+aATP, n = 1). Results: Low VP{\%} (<10{\%}) lead to a nonsignificant reduction in the progression of AF (hazard ratio [HR] 0.80; 95{\%} confidence interval [CI] 0.57–1.13; P =.21; I2 = 67{\%}) compared to high VP{\%} (>10{\%}). APP algorithm reduced premature atrial complexes (PAC) burden (mean difference [MD] –1117.74; 95{\%} CI –1852.36 to –383.11; P =.003; I2 = 67{\%}) but did not decrease AF burden (MD 8.20; 95{\%} CI –5.39 to 21.80; P =.24; I2 = 17{\%}) or AF episodes (MD 0.00; 95{\%} CI –0.24 to 0.25; P =.98; I2 = 0{\%}). Similarly, aATP+APP programming showed no significant difference in AF progression (odds ratio 0.65; 95{\%} CI 0.36–1.14; P =.13; I2 = 61{\%}). No serious adverse events related to algorithm were reported. Conclusion: This meta-analysis of randomized controlled trials demonstrated that algorithms to reduce VP{\%} can be considered safe. Low burden VP{\%} did not significantly suppress AF progression. The atrial pacing therapy algorithms could suppress PAC burden but did not prevent AF progression.",
keywords = "Arial preference pacing, Atrial fibrillation, Atrial pacing therapies, Minimize ventricular pacing, Reduced ventricular pacing",
author = "Munawar, {Dian A.} and Rajiv Mahajan and Agbaedeng, {Thomas A.} and Anand Thiyagarajah and Twomey, {Darragh J.} and Kashif Khokhar and Catherine O'Shea and Young, {Glenn D.} and Roberts-Thomson, {Kurt C.} and Muhammad Munawar and Lau, {Dennis H.} and Prashanthan Sanders",
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Munawar, DA, Mahajan, R, Agbaedeng, TA, Thiyagarajah, A, Twomey, DJ, Khokhar, K, O'Shea, C, Young, GD, Roberts-Thomson, KC, Munawar, M, Lau, DH & Sanders, P 2019, 'Implication of ventricular pacing burden and atrial pacing therapies on the progression of atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials', Heart Rhythm, vol. 16, no. 8, pp. 1204-1214. https://doi.org/10.1016/j.hrthm.2019.02.020

Implication of ventricular pacing burden and atrial pacing therapies on the progression of atrial fibrillation : A systematic review and meta-analysis of randomized controlled trials. / Munawar, Dian A.; Mahajan, Rajiv; Agbaedeng, Thomas A.; Thiyagarajah, Anand; Twomey, Darragh J.; Khokhar, Kashif; O'Shea, Catherine; Young, Glenn D.; Roberts-Thomson, Kurt C.; Munawar, Muhammad; Lau, Dennis H.; Sanders, Prashanthan.

In: Heart Rhythm, Vol. 16, No. 8, 01.08.2019, p. 1204-1214.

Research output: Contribution to journalArticle

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T1 - Implication of ventricular pacing burden and atrial pacing therapies on the progression of atrial fibrillation

T2 - Heart Rhythm

AU - Munawar, Dian A.

AU - Mahajan, Rajiv

AU - Agbaedeng, Thomas A.

AU - Thiyagarajah, Anand

AU - Twomey, Darragh J.

AU - Khokhar, Kashif

AU - O'Shea, Catherine

AU - Young, Glenn D.

AU - Roberts-Thomson, Kurt C.

AU - Munawar, Muhammad

AU - Lau, Dennis H.

AU - Sanders, Prashanthan

PY - 2019/8/1

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N2 - Background: Atrial fibrillation (AF) is common after pacemaker implantation. However, the impact of pacemaker algorithms in AF prevention is not well understood. Objective: The purpose of this study was to evaluate the role of pacing algorithms in preventing AF progression. Methods: A systematic search of articles using the PubMed and Embase databases resulted in a total of 754 references. After exclusions, 21 randomized controlled trials (8336 patients) were analyzed, comprising studies reporting ventricular pacing percentage (VP%) (AAI vs DDD, n = 1; reducing ventricular pacing [RedVP] algorithms, n = 2); and atrial pacing therapies (atrial preference pacing [APP], n = 14; atrial antitachycardia pacing [aATP]+APP, n = 3; RedVP+APP+aATP, n = 1). Results: Low VP% (<10%) lead to a nonsignificant reduction in the progression of AF (hazard ratio [HR] 0.80; 95% confidence interval [CI] 0.57–1.13; P =.21; I2 = 67%) compared to high VP% (>10%). APP algorithm reduced premature atrial complexes (PAC) burden (mean difference [MD] –1117.74; 95% CI –1852.36 to –383.11; P =.003; I2 = 67%) but did not decrease AF burden (MD 8.20; 95% CI –5.39 to 21.80; P =.24; I2 = 17%) or AF episodes (MD 0.00; 95% CI –0.24 to 0.25; P =.98; I2 = 0%). Similarly, aATP+APP programming showed no significant difference in AF progression (odds ratio 0.65; 95% CI 0.36–1.14; P =.13; I2 = 61%). No serious adverse events related to algorithm were reported. Conclusion: This meta-analysis of randomized controlled trials demonstrated that algorithms to reduce VP% can be considered safe. Low burden VP% did not significantly suppress AF progression. The atrial pacing therapy algorithms could suppress PAC burden but did not prevent AF progression.

AB - Background: Atrial fibrillation (AF) is common after pacemaker implantation. However, the impact of pacemaker algorithms in AF prevention is not well understood. Objective: The purpose of this study was to evaluate the role of pacing algorithms in preventing AF progression. Methods: A systematic search of articles using the PubMed and Embase databases resulted in a total of 754 references. After exclusions, 21 randomized controlled trials (8336 patients) were analyzed, comprising studies reporting ventricular pacing percentage (VP%) (AAI vs DDD, n = 1; reducing ventricular pacing [RedVP] algorithms, n = 2); and atrial pacing therapies (atrial preference pacing [APP], n = 14; atrial antitachycardia pacing [aATP]+APP, n = 3; RedVP+APP+aATP, n = 1). Results: Low VP% (<10%) lead to a nonsignificant reduction in the progression of AF (hazard ratio [HR] 0.80; 95% confidence interval [CI] 0.57–1.13; P =.21; I2 = 67%) compared to high VP% (>10%). APP algorithm reduced premature atrial complexes (PAC) burden (mean difference [MD] –1117.74; 95% CI –1852.36 to –383.11; P =.003; I2 = 67%) but did not decrease AF burden (MD 8.20; 95% CI –5.39 to 21.80; P =.24; I2 = 17%) or AF episodes (MD 0.00; 95% CI –0.24 to 0.25; P =.98; I2 = 0%). Similarly, aATP+APP programming showed no significant difference in AF progression (odds ratio 0.65; 95% CI 0.36–1.14; P =.13; I2 = 61%). No serious adverse events related to algorithm were reported. Conclusion: This meta-analysis of randomized controlled trials demonstrated that algorithms to reduce VP% can be considered safe. Low burden VP% did not significantly suppress AF progression. The atrial pacing therapy algorithms could suppress PAC burden but did not prevent AF progression.

KW - Arial preference pacing

KW - Atrial fibrillation

KW - Atrial pacing therapies

KW - Minimize ventricular pacing

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