Systematic review and meta-analysis on the impact on outcomes of device algorithms for minimizing right ventricular pacing

Abstract Aims Physiological activation of the heart using algorithms to minimize right ventricular pacing (RVPm) may be an effective strategy to reduce adverse events in patients requiring anti-bradycardia therapies. This systematic review and meta-analysis aimed to evaluate current evidence on clin...

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Bibliographic Details
Published in:Europace (London, England) Vol. 26; no. 8
Main Authors: Mei, Davide Antonio, Imberti, Jacopo Francesco, Vitolo, Marco, Bonini, Niccolò, Serafini, Kevin, Mantovani, Marta, Tartaglia, Enrico, Birtolo, Chiara, Zuin, Marco, Bertini, Matteo, Boriani, Giuseppe
Format: Journal Article
Language:English
Published: UK Oxford University Press 03.08.2024
Oxford Publishing Limited (England)
Subjects:
Aged
Algorithms
Atrial Fibrillation - diagnosis
Atrial Fibrillation - mortality
Atrial Fibrillation - physiopathology
Atrial Fibrillation - therapy
Atrioventricular Block - physiopathology
Atrioventricular Block - therapy
Bradycardia
Bradycardia - diagnosis
Bradycardia - mortality
Bradycardia - prevention & control
Bradycardia - therapy
Cardiac arrhythmia
Cardiac Pacing, Artificial - methods
Female
Heart
Heart Rate
Heart Ventricles - physiopathology
Hospitalization
Hospitalization - statistics & numerical data
Humans
Male
Meta-Analysis
Pacemaker, Artificial
Risk Factors
Systematic review
Treatment Outcome
Ventricle
Ventricular Function, Right
Heart failure
Algorithms
Pacemaker
Atrial fibrillation
Sinus node dysfunction
Atrioventricular block
Meta-analysis
ISSN:1099-5129, 1532-2092, 1532-2092
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Summary:Abstract Aims Physiological activation of the heart using algorithms to minimize right ventricular pacing (RVPm) may be an effective strategy to reduce adverse events in patients requiring anti-bradycardia therapies. This systematic review and meta-analysis aimed to evaluate current evidence on clinical outcomes for patients treated with RVPm algorithms compared to dual-chamber pacing (DDD). Methods and results We conducted a systematic search of the PubMed database. The predefined endpoints were the occurrence of persistent/permanent atrial fibrillation (PerAF), cardiovascular (CV) hospitalization, all-cause death, and adverse symptoms. We also aimed to explore the differential effects of algorithms in studies enrolling a high percentage of atrioventricular block (AVB) patients. Eight studies (7229 patients) were included in the analysis. Compared to DDD pacing, patients using RVPm algorithms showed a lower risk of PerAF [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.57–0.97] and CV hospitalization (OR 0.77, 95% CI 0.61–0.97). No significant difference was found for all-cause death (OR 1.01, 95% CI 0.78–1.30) or adverse symptoms (OR 1.03, 95% CI 0.81–1.29). No significant interaction was found between the use of the RVPm strategy and studies enrolling a high percentage of AVB patients. The pooled mean RVP percentage for RVPm algorithms was 7.96% (95% CI 3.13–20.25), as compared with 45.11% (95% CI 26.64–76.38) of DDD pacing. Conclusion Algorithms for RVPm may be effective in reducing the risk of PerAF and CV hospitalization in patients requiring anti-bradycardia therapies, without an increased risk of adverse symptoms. These results are also consistent for studies enrolling a high percentage of AVB patients. Graphical Abstract Graphical Abstract
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Conflict of interest: G.B. reports small speaker fees from Bayer, Boehringer Ingelheim, Boston, BMS, Daiichi, Sanofi, and Janssen, outside the submitted work. The other authors do not have conflict of interests to report.
ISSN:1099-5129
1532-2092
1532-2092
DOI:10.1093/europace/euae212