Electrogram-guided Bachmann bundle area pacing to correct interatrial block: Initial experience, safety, and...

Area of Science:

• Electrophysiology
• Cardiac Pacing

Background:

• Standardized Bachmann bundle (BB) capture criteria are lacking, limiting the clinical utility of Bachmann bundle area pacing (BBAP) in patients with interatrial block (IAB).

Purpose of the Study:

• To assess the feasibility and safety of electrogram-guided Bachmann bundle pacing (BBP) using a sheath-assisted, stylet-driven atrial lead implantation technique.

Main Methods:

• A prospective, single-center study enrolled patients with IAB undergoing pacemaker implantation.
• BBAP was attempted using specific delivery sheath and pacing lead.
• Bachmann bundle capture was verified via fluoroscopy, P-wave morphology, electrophysiological criteria, and threshold testing.

Main Results:

• Successful permanent BBAP was achieved in 88.9% of patients.
• IAB correction occurred in 91.7% of those with partial IAB and 75.0% with complete IAB.
• High-frequency BB potentials were recorded in 83.3%, and transition to selective capture was demonstrated in 87.5%.

Conclusions:

• Bachmann bundle area pacing is a feasible technique with a high success rate.
• The procedure is associated with stable capture thresholds during follow-up.