Atrioventricular nodal ablation in atrial fibrillation: a meta-analysis of biventricular vs. right ventricular pacing mode

For patients with refractory atrial fibrillation (AF) undergoing atrioventricular nodal ablation (AVNA), initial single-chamber right ventricular (RV)-only pacing is standard. Given the deleterious effects of chronic RV-only pacing, the impact of an initial biventricular (BiV) pacing strategy post-ablation is of interest. We conducted a meta-analysis to determine the effect of BiV vs. RV-only pacing in patients undergoing AVNA for refractory atrial fibrillation. A search of multiple electronic databases identified 921 reports, which included four randomized controlled trials (n 534). Mean New York Heart Association (NYHA) class was 2.3 and mean left ventricular ejection fraction (LVEF) was 44. When compared with RV-only pacing, BiV pacing was not associated with reduced mortality [risk ratio 0.85, 95 confidence interval (CI) 0.401.82, P 0.68]. In three studies comprised of patients with left ventricular systolic dysfunction (mean EF 41 3), BiV pacing demonstrated a non-significant reduction in cardiac mortality (risk ratio 0.59, 95 CI 0.251.39; P 0.23). Compared with RV-only pacing, BiV pacing was associated with significant improvement in symptoms [Minnesota Living with Heart Failure Questionnaire (MLWHFQ) 2.72 points fewer, 95 CI 1.453.99] and increased LVEF (2.6, 95 CI 1.693.44), but no significant change in 6 min walk distance (6MWD) (5.02 ms more, 95 CI 1.56 to 11.59; P 0.13). In patients with refractory AF undergoing AVNA, BiV pacing was not associated with significantly improved survival when compared with RV-only pacing. A modest, but significant improvement in structural and functional response to BiV pacing was observed.