Bachmann Bundle Pacing Combined with ICD in Hypertrophic Cardiomyopathy with Interatrial Conduction Block

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Management

Background:

• Familial hypertrophic cardiomyopathy (HCM) can cause severe heart failure and interatrial conduction delay (IACD).
• Standard cardiac resynchronization therapy may be unsuitable for some HCM patients due to specific ventricular activation patterns.
• Optimizing atrial synchrony is crucial for improving cardiac function in these patients.

Purpose of the Study:

• To evaluate the efficacy of Bachmann bundle pacing (BBP) combined with a dual-chamber implantable cardioverter-defibrillator (ICD) in a patient with HCM, severe heart failure, and IACD.
• To assess the impact of BBP on interatrial synchrony, left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) functional class.
• To explore BBP as a novel therapeutic strategy for managing complex cardiac conditions in HCM.

Main Methods:

• A 67-year-old male patient with HCM, LVEF 31%, NYHA III, and IACD underwent implantation of a dual-chamber ICD.
• The atrial lead was positioned using Bachmann bundle pacing (BBP) to enhance interatrial synchrony.
• Clinical status, echocardiographic parameters, and P-wave characteristics were monitored post-implantation.

Main Results:

• Bachmann bundle pacing successfully corrected the interatrial conduction delay, evidenced by P-wave shortening and normalization.
• Within one month, the patient showed significant clinical improvement: LVEF increased from 31% to 49%, and NYHA class improved from III to II.
• Echocardiography demonstrated improved left atrial-left ventricular coupling, indicating enhanced cardiac efficiency.

Conclusions:

• The combination of BBP and ICD provides a novel and effective treatment for HCM patients suffering from IACD.
• This strategy offers dual benefits: protection against sudden cardiac death and substantial hemodynamic and functional improvements.
• Optimizing atrial activation and atrioventricular synchrony through BBP is key to achieving these positive outcomes in challenging cardiac cases.