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Reduction in new-onset device-detected atrial fibrillation: A prospective 2-center study comparing left bundle branch pacing with conventional right ventricular pacing

Year: 2025

Type: article

Abstract: Background Right ventricular pacing (RVP) has been associated with an increased risk of atrial fibrillation (AF). Objective We aim to compare the incidence of new-onset AF between left bundle branch pacing (LBBP) and RVP. Methods We conducted a prospective, observational, two-center study recruiting patients with pacemaker implantation who were at high risk for developing AF(i.e., over 70 years old). The primary endpoint was time to the first occurrence of device-detected AF with clinical significance (i.e., > 6 minutes), while the secondary endpoint was time to the first episode of AF that could require oral anticoagulation (i.e., >24 hours). Multivariate Cox regression models were used to evaluate the effect of LBBP on AF occurrence. Results The final evaluation included 412 patients (212 in the LBBP group and 200 in the RVP group). LBBP showed a lower incidence of AF > 6 minutes compared to RVP (27.4%vs.42%,p=0.003). Multivariate analysis showed that LBBP presented a lower hazard ratio (HR) for AF >6 minutes compared with RVP: HR [95%(CI)]:0.575(0.411-0.804),log-rank p=0.001. Among patients with VP≥20%, LBBP was associated with a lower risk of AF compared with RVP: HR(95% CI):0.510(0.341-0.764),p=0.001. LBBP demonstrated a reduced risk of new-onset AF lasting longer than 24 hours compared to RVP (9.4%vs.25%,p<0.001). Multivariate analysis further confirmed that LBBP had a lower HR than RVP: HR[95%(CI)]:0.354(0.210-0.595), log-rank p<0.001. Conclusion LBBP reduced the risk of new-onset device-detected AF lasting longer than 6 minutes and decreased the likelihood of new-onset AF episodes exceeding 24 hours, compared to RVP in a high-risk population for AF development.

Source: Heart Rhythm O2

DOI: 10.1016/j.hroo.2025.12.009