New-Onset Atrial High-Rate Episodes in Left Bundle Branch Area Pacing Versus Right Ventricular Pacing for Patients With Atrioventricular Block

Abstract Purpose Left bundle branch area pacing (LBBAP) has demonstrated beneficial effects on clinical outcomes. Comparative data on the risk of atrial high-rate episodes (AHREs) between LBBAP and right ventricular pacing (RVP) are lacking. This study aimed to investigate whether LBBAP can reduce the risk of new-onset AHREs compared with RVP in patients with atrioventricular block (AVB). Methods A total of 175 consecutive AVB patients undergoing dual-chamber pacemaker implantation (LBBAP or RVP) and with no history of atrial fibrillation were enrolled. Propensity score matching for baseline characteristics yielded 43 matched pairs. The primary outcome was new-onset AHREs detected on scheduled device follow-up. Changes in echocardiographic measurements were also compared between groups. Results New-onset AHREs occurred in 42(24.0%) of all enrolled patients (follow-up 14.1 ± 7.5 months) and the incidence of new-onset AHREs in the LBBAP group was significantly lower than RVP (19.8% vs 34.7%, P = 0.039). After propensity score matching, LBBAP still resulted in significantly lower incidence of new-onset AHREs (11.6% vs 32.6%, P = 0.019), and a lower hazard ratio for new-onset AHREs compared with RVP (HR 0.274; 95% CI 0.113–0.692). At 1 year, LBBAP achieved preserved left ventricular ejection fraction (LVEF) (63.0 ± 3.2% to 63.1 ± 0.8%, P = 0.562), while RVP resulted in reduced LVEF (63.4 ± 4.9% to 60.5 ± 0.8%, P = 0.01). Changes in LVEF were significantly different between 2 groups {2.6% (0.2 to 5.0), P = 0.031}. Conclusion LBBAP demonstrated a reduced risk of new-onset AHREs compared with RVP in patients with AVB.