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Pacing of Bachmann's bundle after coronary artery bypass grafting
Andreas Goette1, Joerg Mittag, Andrea Friedl
1Department of Internal Medicine, University Hospital Magdeburg, Germany. andreas.goette@medizin.uni-magdeburg.de
Insights
Bachmann's bundle pacing did not reduce overall AF incidence post-CABG. However, this site showed better pacing capabilities and reduced AF during pacing, making it preferable for atrial pacing if needed.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Postoperative atrial fibrillation (AF) is a common complication after coronary artery bypass grafting (CABG).
- Atrial pacing strategies are explored to mitigate AF risk.
- Bachmann's bundle is an anatomical target for atrial pacing.
Purpose of the Study:
- To evaluate if Bachmann's bundle pacing reduces AF incidence following CABG.
- To compare the efficacy and safety of Bachmann's bundle pacing versus right atrial wall pacing.
Main Methods:
- A randomized, prospective trial involving 161 patients undergoing CABG without prior AF.
- Patients were assigned to control, right atrial wall pacing, or Bachmann's bundle pacing groups.
- Atrial pacing was initiated post-CABG and continued for 5 days; AF occurrence was the primary endpoint.
Main Results:
- Overall AF incidence was not significantly reduced by Bachmann's bundle pacing compared to controls (37% vs. 42%).
- Paced P wave duration was shorter with Bachmann's bundle pacing and identified as a risk factor for AF.
- AF incidence was lower during Bachmann's bundle pacing compared to right atrial pacing (29% vs. 50%).
Conclusions:
- Anatomically guided Bachmann's bundle pacing does not decrease overall postoperative AF incidence post-CABG.
- Bachmann's bundle pacing demonstrates favorable pacing capabilities and reduced AF during pacing.
- It is a preferable site for electrode placement if postoperative atrial pacing is required.
Abstract:
The purpose of this randomized, prospective trial was to determine if Bachmann's bundle pacing reduces the incidence of AF after CABG. The study included 161 patients with no history of AF who were randomized to three groups. Group 1 included 50 patients as controls. Group 2 included 60 patients who had an epicardial wire placed at the lateral wall of the right atrium. In the 51 patients of group 3, the wire was placed at the Bachmann's bundle. In groups 2 and 3, atrial pacing (AAI 96 beats/min) was initiated immediately after CABG and continued for 5 days. The study endpoint was AF lasting > or = 1 minute. Baseline clinical parameters were similar in all three groups. The incidence of AF was not reduced by pacing (group 1: 42%; group 2:48%; group 3:37%; P = NS). The paced P wave duration was increased in group 2 (129 +/- 14 ms vs group 3: 96 +/- 21 ms; P < 0.05). Paced P wave duration was a risk factor for postoperative AF (odds ratio 1.015; 95% CI 1.0021-1.028; P < 0.05). Analysis comparing the pacing groups revealed a reduction in AF during Bachmann's bundle pacing (50 vs 29%; P < 0.01). Pacing thresholds were significantly better at Bachmann's bundle compared to group 2. In conclusion, an anatomically guided pacing at the Bachmann's bundle does not reduce the overall incidence of postoperative AF compared to controls. However, the Bachmann's bundle offers favorable capabilities for postoperative a trial pacing, and thus it is a preferable site for electrode placement if postoperative atrial pacing is required.