Atrial electrogram amplitude-guided Bachmann bundle pacing implantation: A single-center experience

Bachmann bundle pacing (BBp) seems to be associated with reduced incidence and persistence of atrial fibrillation. The Bachmann bundle area is located at the junction between the superior vena cava and the right atrium. Pacemaker leads were implanted just inferior to a site demonstrating an abrupt increase in electrogram amplitude as the lead delivery system was advanced inferoseptally from the superior vena cava toward the right atrium as long as adequate sensing and capture thresholds were demonstrated. Subsequent to the implant, paced P waves were evaluated for evidence of Bachmann bundle capture.

This study aimed to evaluate the feasibility, safety, and short-term outcomes of an atrial electrogram amplitude-guided implantation strategy for BBp.

We retrospectively included 50 patients who underwent dual-chamber pacemaker or implantable cardioverter-defibrillator implantation with attempted BBp between September 2023 and December 2024. The atrial pacing lead was fixed just below the site demonstrating an abrupt change in atrial electrogram amplitude, typically exceeding 1 mV.

Atrial septal lead implantation was achieved in all patients, with successful BBp (meeting electrocardiogram criteria) in 44 (88%). The median mapping time was 134.5 seconds. Immediately after fixing the lead, the mean capture threshold was 1.86 ± 1.00 V at 0.4 ms, improving to 0.834 ± 0.315 V by the end of the procedure. During the 6-month follow-up, pacing parameters remained stable, with no lead dislodgement, pericardial effusion, or device-related infection.

BBp using the lumenless pacing lead and delivery catheter, guided by an atrial electrogram amplitude-based strategy, is safe, feasible, and reproducible.