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.