Customized Sheath Modification for Bachmann Bundle Area Pacing With a Stylet-Driven Lead

Bachmann bundle area pacing (BBp) has primarily been performed using lumenless leads delivered through dedicated atrial sheaths. With stylet-driven leads, stable positioning at the superior interatrial septum can be technically challenging. We report two patients in whom the distal portion of a standard ventricular delivery catheter was shortened and reshaped using controlled heat molding with a heat gun. The customized sheath enabled stable placement of a stylet-driven lead at the high interatrial septum, resulting in successful BBp with favorable electrical parameters. Customized sheath modification may facilitate BBp using conventional pacing systems. Clinical Trial Registration: This study was not registered in a clinical trial registration, as it represents a retrospective case series and dose not meet the criteria for a prospective interventional clinical trial.