ArticleJACC. Asia2026
Persistent Atrial Fibrillation With Conduction System Pacing or Pulmonary Vein Isolation: A Prospective Cohort Study.
Article in JACC. Asia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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1 citing paper in PubMed.
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14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundConduction system pacing (CSP) combined with atrioventricular node ablation (AVNA) is a feasible option for symptomatic atrial fibrillation (AF), but comparative studies with pulmonary vein isolation (PVI) are limited.
objectivesThe aim of this study was to compare the clinical outcomes of CSP+AVNA and PVI in patients with persistent AF and a left atrial size.
methodsThis observational study included patients with persistent AF and a left atrial size >50 mm received PVI or CSP+AVNA (ablate and pace [AP]) from 2016 to 2022. Clinical outcomes, AF recurrence, and the composite endpoint of heart failure hospitalization and cardiac death were assessed.
resultsOut of 718 screened patients, 473 received PVI and 245 received AP. The AP strategy was associated with higher composite risk in univariate analysis (HR: 2.84; 95% CI: 1.79-4.50; P < 0.001) but not after multivariate adjustment (HR: 1.10; 95% CI: 0.54-2.23; P = 0.795). After 1:1 matching (n = 174), left ventricular ejection fraction improved similarly in both groups. Over an average 40 months' follow-up, the composite endpoint was similar between groups (propensity score matching [PSM]-AP: 14.9% vs PSM-PVI: 16.1%; P = 0.864). AF recurred in 54.0% in the PSM-PVI group and atrioventricular conduction recurred in 1.2% in the PSM-AP group.
conclusionsIn this observational study, outcomes were numerically similar between PVI and AP in patients with persistent AF and enlarged left atria. Given the limited sample size and residual confounding, these results should be considered hypothesis-generating pending confirmation from randomized trials.
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