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

<h2>ABSTRACT</h2><h3>Background</h3> Right ventricular pacing (RVP) has been associated with an increased risk of atrial fibrillation (AF). <h3>Objective</h3> We aim to compare the incidence of new-onset AF between left bundle branch pacing (LBBP) and RVP. <h3>Methods</h3> 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. <h3>Results</h3> 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. <h3>Conclusion</h3> 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.