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

Abstract

BackgroundA lack of standard Bachman Bundle(BB) capture criteria has affected the clinical impact of Bachmann Bundle Area Pacing(BBAP) in patients with inter-atrial block(IAB). ObjectiveWe evaluated the feasibility and safety of electrogram guided BBP using sheath assisted, stylet-driven atrial lead implantation. MethodsPatients with a baseline IAB undergoing dual chamber PPI or ICD implantation were enrolled in a single center,prospective study. BBAP was attempted in all patients with the aid of 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 the recording of a high frequency BB potential and a transition between non-selective(NS) to selective(S) BB capture during threshold testing. Procedure-related complications,lead parameters,and P wave morphology were assessed at implantation and follow up. ResultsPermanent BBAP was successful in 32 of the 36(88.9%) enrolled patients. Baseline P wave duration was 148.5+16.1ms. Among patients who underwent successful BBP, the final paced P wave duration was 117.8+19.6ms. There was a correction of the partial or complete interatrial block in 22(91.7%) and 6(75.0%) patients, respectively. BB potentials were recorded in 83.3% of all study patients.A transition from NS to S-BB capture could be demonstrated during threshold testing in 22(87.5%) patients. The only major complications were 2 BBAP lead dislodgements within 24 hours and a rise in pacing impedance at 3 weeks in 1 patient. ConclusionBBAP is feasible in a high percentage of patients and is associated with stable capture thresholds during follow up.