Leadless pacemakers were associated with a significantly lower risk of incident atrial fibrillation compared to transvenous devices (p=0.049), with effects modified by ventricular pacing burden.
Cohort
Does leadless pacemaker implantation reduce incident clinical atrial fibrillation compared to transvenous pacemakers in patients without prior atrial fibrillation?
Leadless pacemakers may be associated with a lower risk of incident atrial fibrillation compared to transvenous pacemakers, an effect modified by ventricular pacing burden.
p-value: p=0.049
ABSTRACT Background Atrial fibrillation (AF) after pacemaker (PM) implantation is associated with adverse outcomes; however, the relationship between left atrial remodeling, device type, and ventricular pacing burden remains unclear. Objective We aimed to investigate (1) whether post‐implantation changes in left atrial diameter (ΔLAD) are associated with incident AF; (2) differences in AF and ΔLAD between TVP and LP; and (3) whether mean ventricular pacing percentage (Vp%) modifies device‐related effects. Methods This retrospective study included patients without a prior history of AF who underwent PM implantation. The primary outcome was defined as incident clinical AF, which was analyzed using Cox hazard models. Mechanistic models incorporating Vp% and paced QRS duration were also evaluated. Interaction analyses were performed using mean‐centered Vp % (device × Vp) and Vp%‐stratified analyses. To mitigate reverse causality, a landmark analysis excluding AF events within 1 year after implantation was conducted. Results In the pooled Cox analyses, ΔLAD was independently associated with incident AF ( p < 0.0001). No significant difference in ΔLAD was observed between the TVP and LP groups ( p = 0.417). In models adjusted for ΔLAD, LP was associated with a significantly lower risk of AF (device, p = 0.049; ΔLAD, p < 0.0001). Vp% and paced QRS duration were not significant main effects. However, a significant device × Vp interaction was observed in the mean‐centered interaction models ( p = 0.022). In landmark analyses, ΔLAD remained associated with AF beyond 1 year ( p = 0.0013). Conclusion Left atrial remodeling independently predicted incident AF after pacemaker implantation. LP was associated with a lower AF risk, with effects modified by the pacing burden.
Inoue et al. (Sat,) conducted a cohort in Pacemaker implantation without prior atrial fibrillation. Leadless pacemaker (LP) vs. Transvenous pacemaker (TVP) was evaluated on Incident clinical atrial fibrillation (p=0.049). Leadless pacemakers were associated with a significantly lower risk of incident atrial fibrillation compared to transvenous devices (p=0.049), with effects modified by ventricular pacing burden.