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

This case presents a 67-year-old man with familial hypertrophic cardiomyopathy, severe heart failure (LVEF 31%, NYHA III), and significant interatrial conduction delay. After ruling out cardiac resynchronization therapy due to unsuitable ventricular activation characteristics, a dual-chamber implantable cardioverter-defibrillator was implanted, using Bachmann bundle pacing for the atrial lead to optimize interatrial synchrony. BBP successfully corrected the IACD, evidenced by P-wave shortening and normalization. This led to remarkable clinical improvements within 1 month: LVEF increased from 31% to 49%, and NYHA class improved from III to II. Echocardiography confirmed enhanced left atrial-left ventricular coupling. This case demonstrates BBP combined with ICD as a novel and effective strategy for HCM patients with IACD, offering both sudden cardiac death protection and substantial hemodynamic and functional benefits by optimizing atrial activation and atrioventricular synchrony.