Interatrial Synchronized Pacing at the Posterosuperior Bundle: Feasibility, Mechanism, and Mid-Term Outcomes
Zhaohui Qiu1, Wu Xianhao1, Wei Hu1
1Department of Cardiology (Z.Q., X.W., W.H., Z.X., Z.O., Y.Z.), Shanghai Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Circulation. Arrhythmia and Electrophysiology
|December 25, 2025
Summary
Posterosuperior bundle (PSB) pacing is a safe and effective atrial pacing method. This technique maintains interatrial electrical synchrony and shows promise for patients with conduction delays.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Conventional right atrial appendage pacing can disrupt interatrial synchrony.
- Posterosuperior bundle (PSB) pacing targets the interatrial muscular connection in the superior vena cava.
- PSB pacing offers potential anatomical advantages for atrial pacing.
Purpose of the Study:
- To validate the feasibility of PSB pacing.
- To evaluate mid-term clinical outcomes of PSB pacing.
- To assess the impact of PSB pacing on interatrial synchrony.
Main Methods:
- Retrospective cohort analysis of 33 patients undergoing PSB pacing.
- Lead placement in the medial wall of the superior vena cava.
- Assessment of electrophysiological and echocardiographic parameters pre- and post-procedure.
Main Results:
- 100% procedural success with stable lead parameters and no complications.
- Significant reduction in P-wave duration, especially in patients with conduction delay.
- Maintained echocardiographic parameters and minimal clinical events.
Conclusions:
- PSB pacing is a feasible, safe, and effective atrial pacing strategy.
- It preserves interatrial electrical synchrony and offers functional benefits.
- PSB pacing is a promising alternative for physiological atrial pacing.
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