Leadless Atrial Pacing at Bachmann's Bundle Guided by Electroanatomic Mapping and Intracardiac Ultrasound.

INTRODUCTION

Leadless pacemakers (LPs) offer advantages over transvenous systems, but atrial LPs currently target the right atrial appendage (RAA), risking atrial dyssynchrony.

METHODS AND

RESULTS

We report five patients in whom electroanatomic mapping and intracardiac ultrasound guided LP implantation into Bachmann's bundle (BB), a site shown to improve interatrial conduction and reduce atrial fibrillation risk. In four of five patients, BB fixation was successful with low pacing thresholds and short P-wave duration. One patient required conversion to RAA pacing due to high BB pacing thresholds. No intraprocedural complications occurred.

CONCLUSIONS

This series demonstrates the feasibility of leadless BB pacing, though technical challenges warrant further study.