Comparison of Invasive Left Atrial Pressure Between Bachmann's Bundle and Right Atrial Appendage Pacing

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Pacing

Background:

• Bachmann's bundle pacing (BBP) is linked to shorter p-wave duration (PWD) and reduced atrial fibrillation (AF) recurrence compared to right atrial appendage pacing (RAAP).
• Investigating acute left atrial pressure (LAP) differences between sinus rhythm, BBP, and RAAP is crucial for understanding pacing mechanisms.

Purpose of the Study:

• To compare acute left atrial pressure (LAP) invasively measured during sinus rhythm, Bachmann's bundle pacing (BBP), and right atrial appendage pacing (RAAP).
• To determine the relationship between p-wave duration (PWD) and acute LAP during different pacing modes.

Main Methods:

• Acute LAP and PWD were measured in 26 subjects undergoing left atrial catheter ablation.
• Paired t-tests were used to analyze differences in PWD and LAP between sinus rhythm, BBP, and RAAP.
• Subgroup analyses were performed based on interatrial conduction delay, AF type, and left ventricular ejection fraction.

Main Results:

• BBP was associated with significantly shorter PWD compared to sinus rhythm and RAAP (p < 0.05).
• Overall acute LAP was not significantly different between BBP, sinus rhythm, and RAAP (p > 0.05).
• In patients with interatrial conduction delay, BBP was associated with significantly shorter PWD and lower acute LAP compared to RAAP (p = 0.010).

Conclusions:

• Reductions in PWD during BBP do not consistently translate to reductions in acute LAP.
• While acute LAP was lower with BBP compared to RAAP in a specific subgroup, its clinical significance in reducing AF requires further investigation.