Electrogram-guided Bachmann bundle area pacing to correct interatrial block: Initial experience, safety, and feasibility.

BACKGROUND

A lack of standard Bachmann bundle (BB) capture criteria has affected the clinical impact of Bachmann bundle area pacing (BBAP) in patients with interatrial block (IAB).

OBJECTIVE

The purpose of this study was to evaluate the feasibility and safety of electrogram-guided Bachmann bundle pacing (BBP) using sheath assisted, stylet-driven atrial lead implantation.

METHODS

Patients with baseline IAB undergoing dual-chamber pacemaker or implantable cardioverter-defibrillator implantation were enrolled in a single-center prospective study. BBAP was attempted in all patients using a Selectra 3D S-40 delivery sheath and Solia S-60 pacing lead. BB capture was confirmed using a combination of fluoroscopy, P-wave morphology, and electrophysiological criteria. These included recording of a high-frequency BB potential and transition between nonselective and selective BB capture during threshold testing. Procedure-related complications, lead parameters, and P-wave morphology were assessed at implantation and follow-up.

RESULTS

Permanent BBAP was successful in 32 of the 36 enrolled patients (88.9%). Baseline P-wave duration was 148.5 ± 16.1 ms. Among patients who underwent successful BBP, final paced P-wave duration was 117.8 ± 19.6ms. Correction of partial or complete IAB occurred in 22 patients (91.7%) and 6 patients (75.0%), respectively. BB potentials were recorded in 83.3% of all study patients. Transition from NS to S BB capture could be demonstrated during threshold testing in 22 patients (87.5%). The only major complications were 2 BBAP lead dislodgments within 24 hours and a rise in pacing impedance at 3 weeks in 1 patient.

CONCLUSION

BBAP is feasible in a high percentage of patients and is associated with stable capture thresholds during follow-up.