Reduction in unnecessary ventricular pacing fails to affect hard clinical outcomes in patients with preserved left ventricular function: a meta-analysis.
Several pacing modalities across multiple manufacturers have been introduced to minimize unnecessary right ventricular pacing. We conducted a meta-analysis to assess whether ventricular pacing reduction modalities (VPRM) influence hard clinical outcomes in comparison to standard dual-chamber pacing (DDD).



An electronic search was performed using Cochrane Central Register, PubMed, Embase, and Scopus. Only randomized controlled trials (RCT) were included in this analysis. Outcomes of interest included: frequency of ventricular pacing (VP), incident persistent/permanent atrial fibrillation (PerAF), all-cause hospitalization and all-cause mortality. Odds ratios (OR) were reported for dichotomous variables. Seven RCTs involving 4119 adult patients were identified. Ventricular pacing reduction modalities were employed in 2069 patients: (MVP, Medtronic Inc.) in 1423 and (SafeR, Sorin CRM, Clamart) in 646 patients. Baseline demographics and clinical characteristics were similar between VPRM and DDD groups. The mean follow-up period was 2.5 ± 0.9 years. Ventricular pacing reduction modalities showed uniform reduction in VP in comparison to DDD groups among all individual studies. The incidence of PerAF was similar between both groups {8 vs. 10%, OR 0.84 [95% confidence interval (CI) 0.57; 1.24], P = 0.38}. Ventricular pacing reduction modalities showed no significant differences in comparison to DDD for all-cause hospitalization or all-cause mortality [9 vs. 11%, OR 0.82 (95% CI 0.65; 1.03), P= 0.09; 6 vs. 6%, OR 0.97 (95% CI 0.74; 1.28), P = 0.84, respectively].



Novel VPRM measures effectively reduce VP in comparison to standard DDD. When actively programmed, VPRM did not improve clinical outcomes and were not superior to standard DDD programming in reducing incidence of PerAF, all-cause hospitalization, or all-cause mortality.
Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Room E241, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.|Arrhythmia Services, Cardiology Department, An-Najah National University Hospital, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
Mohammed
M
Shurrab
Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Jeff S
JS
Healey
Arrhythmia Services, Cardiology Department, An-Najah National University Hospital, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine|Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
Saleem
S
Haj-Yahia
School of Medicine, St. Matthew's University, West Bay, Cayman Islands.
Anna
A
Kaoutskaia
Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41124 Modena, Italy.
Giuseppe
G
Boriani
Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Aldo
A
Carrizo
S. Anna Hospital, Como, Italy.
Gianluca
G
Botto
Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Room E241, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
David
D
Newman
Cardiology Department, University of Firenze, Firenze, Italy|IRCCS Multimedica, Milano, Italy
Luigi
L
Padeletti
Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Stuart J
SJ
Connolly
Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Room E241, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
Eugene
E
Crystal
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002423:Cause of Death; D005260:Female; D006325:Heart Atria; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D009026:Mortality; D016017:Odds Ratio; D019564:Unnecessary Procedures; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right