Munawar, D.A.Mahajan, R.Agbaedeng, T.A.Thiyagarajah, A.Twomey, D.J.Khokhar, K.O'shea, C.Young, G.D.Roberts-Thomson, K.C.Munawar, M.Lau, D.H.Sanders, P.2019-09-232019-09-232019Heart Rhythm, 2019; 16(8):1204-12141547-52711556-3871http://hdl.handle.net/2440/121174BACKGROUND:Atrial fibrillation (AF) is common after pacemaker implantation. However, the impact of pacemaker algorithms in AF prevention is not well understood. OBJECTIVE:The purpose of this study was to evaluate the role of pacing algorithms in preventing AF progression. METHODS:A systematic search of articles using the PubMed and Embase databases resulted in a total of 754 references. After exclusions, 21 randomized controlled trials (8336 patients) were analyzed, comprising studies reporting ventricular pacing percentage (VP%) (AAI vs DDD, n = 1; reducing ventricular pacing [RedVP] algorithms, n = 2); and atrial pacing therapies (atrial preference pacing [APP], n = 14; atrial antitachycardia pacing [aATP]+APP, n = 3; RedVP+APP+aATP, n = 1). RESULTS:Low VP% (<10%) lead to a nonsignificant reduction in the progression of AF (hazard ratio [HR] 0.80; 95% confidence interval [CI] 0.57-1.13; P = .21; I2 = 67%) compared to high VP% (>10%). APP algorithm reduced premature atrial complexes (PAC) burden (mean difference [MD] -1117.74; 95% CI -1852.36 to -383.11; P = .003; I2 = 67%) but did not decrease AF burden (MD 8.20; 95% CI -5.39 to 21.80; P = .24; I2 = 17%) or AF episodes (MD 0.00; 95% CI -0.24 to 0.25; P = .98; I2 = 0%). Similarly, aATP+APP programming showed no significant difference in AF progression (odds ratio 0.65; 95% CI 0.36-1.14; P = .13; I2 = 61%). No serious adverse events related to algorithm were reported. CONCLUSION:This meta-analysis of randomized controlled trials demonstrated that algorithms to reduce VP% can be considered safe. Low burden VP% did not significantly suppress AF progression. The atrial pacing therapy algorithms could suppress PAC burden but did not prevent AF progression.enCrown Copyright © 2019 Published by Elsevier Inc. on behalf ofHeart Rhythm Society. All rights reserved.Arial preventive pacingAtrial fibrillationAtrial pacing therapiesMinimize ventricular pacingReduced ventricular pacingJournal article003010883210.1016/j.hrthm.2019.02.0200004775707000182-s2.0-85069001805460766Munawar, D.A. [0000-0002-9273-8832]Mahajan, R. [0000-0003-3375-5568]Agbaedeng, T.A. [0000-0002-4399-9139]Khokhar, K. [0000-0003-0896-2039]O'shea, C. [0000-0002-5068-6106]Lau, D.H. [0000-0001-7753-1318] [0000-0002-1564-439X]Sanders, P. [0000-0003-3803-8429]