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Войти в исследования Heart rhythm · 2026
P-wave morphology of Bachmann bundle pacing based on electroanatomic mapping and intracardiac echocardiography.
СтатьяНазвание и аннотация: Перевод в очереди
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Yamashita Soichiro, Takami Mitsuru, Imamura Kimitake, Ito Mitsuaki, Tani Kenichi, Fujimoto Wataru, Kuroda Koji, Imanishi Junichi, Iwasaki Masamichi, Todoroki Takafumi, Okuda Masanori, Shimane Akira, Fukuzawa Koji, Lustgarten Daniel L
Аннотация
BACKGROUND: Optimal criteria for Bachmann bundle (BB) pacing have not been established with direct anatomic visualization of BB engagement.
OBJECTIVE: This study aimed to further characterize the optimal site for BB pacing incorporating local electrogram (EGM) and P-wave morphology.
METHODS: This study included 20 patients who underwent a catheter ablation for atrial fibrillation. First, the right atrial BB insertion (BBRA) was identified anatomically by electroanatomic mapping (EAM) and intracardiac echocardiography. Local EGMs at and surrounding the anatomically defined BB were analyzed using a multipolar planar mapping catheter. Second, pace mapping was performed at 5 areas around and within the BB, and their P-wave morphologies were analyzed.
RESULTS: In all cases, the echocardiographically identified BB was consistent with the BB determined by EAM. Local EGMs at the BBRA vary morphologically. In the P-wave morphology of the BBRA pacing, (1) the 12-lead P-wave axes recapitulated normal sinus rhythm (SR) P waves, (2) inferior P-wave amplitude increased with BB capture relative to the native SR P wave, (3) the P-wave duration was >10 ms shorter than that of the SR, and (4) there was no isoelectric interval pacing centrally at the right atrial BB breakout area. If all these 4 criteria are met, the BB can be predicted with 95% sensitivity and 86% specificity.
CONCLUSION: Using a combined definition of the BB using EAM and intracardiac echocardiography, paced P-wave parameters were identified that can be used to confirm BB capture with high sensitivity and specificity, which could be useful when targeting the BB for permanent atrial pacing.
OBJECTIVE: This study aimed to further characterize the optimal site for BB pacing incorporating local electrogram (EGM) and P-wave morphology.
METHODS: This study included 20 patients who underwent a catheter ablation for atrial fibrillation. First, the right atrial BB insertion (BBRA) was identified anatomically by electroanatomic mapping (EAM) and intracardiac echocardiography. Local EGMs at and surrounding the anatomically defined BB were analyzed using a multipolar planar mapping catheter. Second, pace mapping was performed at 5 areas around and within the BB, and their P-wave morphologies were analyzed.
RESULTS: In all cases, the echocardiographically identified BB was consistent with the BB determined by EAM. Local EGMs at the BBRA vary morphologically. In the P-wave morphology of the BBRA pacing, (1) the 12-lead P-wave axes recapitulated normal sinus rhythm (SR) P waves, (2) inferior P-wave amplitude increased with BB capture relative to the native SR P wave, (3) the P-wave duration was >10 ms shorter than that of the SR, and (4) there was no isoelectric interval pacing centrally at the right atrial BB breakout area. If all these 4 criteria are met, the BB can be predicted with 95% sensitivity and 86% specificity.
CONCLUSION: Using a combined definition of the BB using EAM and intracardiac echocardiography, paced P-wave parameters were identified that can be used to confirm BB capture with high sensitivity and specificity, which could be useful when targeting the BB for permanent atrial pacing.