Long-Term Effects of Left Bundle Branch Area Pacing Versus Traditional Right Ventricular Pacing on Atrial Fibrillation After Dual-Chamber Pacemaker Implantation

Abstract

Background

Traditional right ventricular pacing (RVP) can lead to asynchronous cardiac mechanical contractions and increase the risk of atrial fibrillation (AF). This study aimed to compare the occurrence of new-onset AF and the progression of AF between novel physiological pacing—left bundle branch area pacing (LBBAP) and RVP with a long-term follow-up.

Methods and Results

Patients with a dual-chamber permanent pacemaker initial implantation, no history of persistent AF, and an expected high proportion of ventricular pacing (VP ≥ 20%) were included in this retrospective cohort study (LBBAP, n = 122; RVP, n = 166). The pacing QRS duration (QRSd) of the LBBAP was significantly shorter than that of the RVP (113 ± 22 vs. 140 ± 27 ms, p < 0.001), while the intrinsic QRSd values from the two groups were comparable. During a mean follow-up of 21.9 ± 9.4 months, the composite outcome of postoperative new-onset AF or AF progression was higher in the RVP group than in the LBBAP group (RVP HR 2.62, 95%CI 1.21–5.67, p = 0.014). Left ventricular end-diastolic diameter (LVEDD) levels decreased in the LBBAP group at 1 year follow-up (50 ± 6 vs. baseline 48 ± 6, p = 0.002).

Conclusions

In a mean follow-up period of 2 years, compared to RVP, LBBAP patients with VP ≥ 20% had a decreased risk of occurrence and progression of AF events.