Does Minimizing Ventricular Pacing Reduce the Incidence of Atrial Fibrillation? A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background: Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fibrillation (AF). However, whether algorithms for minimizing ventricular pacing reduce the incidence of AF remains controversial. Therefore, we conducted a systematic review and meta-analysis to compare the incidence of AF between minimizing ventricular pacing and conventional pacing protocols in patients with pacemakers implanted. Methods: The PubMed, Embase, and Cochrane Library databases were searched up to August 1, 2017, for rand-omized controlled trials that reported the incidence of AF in patients with and without the use of algorithms for minimizing ventricular pacing. Results: Eleven studies comprising 5705 participants (61% males, mean age 71 years [standard deviation 11 years]) were finally included in the analysis. The mean follow-up duration was 24 months. Use of algorithms for minimizing ventricular pacing significantly reduced the incidence of AF, with an odds ratio of 0.74 (95% confidence interval 0.55-1.00; P<0.05). There was moderate heterogeneity among studies (I² = 63%). Conclusions: The incidence of AF was reduced by 26% with use of algorithms for minimizing ventricular pacing. The incorporation of such algorithms in routine clinical practice should in theory lead to a decrease in AF-related morbidity and mortality.