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

Background: 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. (C) 2016 Elsevier Ireland Ltd. All rights reserved.