Bachmann’s Bundle Pacing not Only Improves Interatrial Conduction but Also Reduces the Need for Ventricular Pacing

Abstract

in a surface electrocardiogram. A slower inter atrial conduction takes place in the coronary si nus. The physiological left atrial contraction de lay amounts to 22 ± 11 ms in relation to the right atrium [1][2][3].The interatrial conduction disorders are rela tively common in sick sinus syndrome patients, which contribute to atrial arrhythmias, in par The implantation of a permanent pacemaker alters the electrophysiological and hemodynam ic relations in a heart. The electrical physiologi cal activation of the atria comes from the sino atrial node. The left atrium activation is achieved throughout the conductive tissue layer called the Objectives. This study was aimed to assess the influence of the atrial pacing site on interatrial and atrioventricular conduction as well as the percentage of ventricular pacing in patients with sick sinus syndrome implanted with atrioventricular pacemaker. Material and Methods. The study population: 96 patients (58 females, 38 males) aged 74.1 ± 11.8 years were divided in two groups: Group 1 (n = 44) with right atrial appendage pacing and group 2 (n = 52) with Bachmann's area pacing. We assessed the differences in atrioventricular conduction in sinus rhythm and atrial 60 and 90 bpm pacing, Pwave duration and percentage of ventricular pacing. Results. No differences in baseline Pwave duration in sinus rhythm between the groups (102.4 ± 17 ms vs. 104.1 ± 26 ms, p = ns.) were noted. Atrial pacing 60 bpm resulted in longer Pwave in group 1 vs. group 2 (138.3 ± 21 vs. 106.1 ± 15 ms, p < 0.01). The differences between atrioventricular conduction time during sinus rhythm and atrial pacing at 60 and 90 bpm were significantly longer in patients with right atrial appendage vs. Bachmann's pacing (44.1 ± 17 vs. 9.2 ± 7 ms p < 0.01 and 69.2 ± 31 vs. 21.4 ± 12 ms p < 0.05, respectively). The percentage of ventricular pacing was higher in group 1 (21 vs. 4%, p < 0.01). Conclusions. Bachmann's bundle pacing decreases interatrial and atrioventricular conduction delay. Moreover, the frequencydependent atrioventricular conduction lengthening is much less pronounced during Bachmann's bundle pacing. Right atrial appendage pacing in sick sinus syndrome patients promotes a higher percentage of ventricular pacing (Adv Clin Exp Med 2016, 25, 5, 845-850).

Dlaczego warto stymulować pęczek Bachmanna? Rozważania elektrokardiograficzne i kliniczne

“…The Bachmann's bundle pacing provides another advantage, as described by our team recently. If the activation of the Bachmann's bundle occurs slightly anteriorly, it facilitates atrioventricular conduction [10]. In the setting of a longer atrioventricular conduction, even the small shortening of atrioventricular conduction can be advantageous in many respects.…”

Cardiac Stimulation in the Third Millennium: Where Do We Head from Here?

“…The atrial stimulation site seems to impact on the risk of new-onset AF more than AP percentage. High-septal atrial pacing near Bachmann's bundle seems to prevent the negative effects of RAA pacing: proximity to Bachmann's bundle decreases interatrial and AV conduction delay [10].…”

Pacemaker-induced atrial fibrillation reconsidered—associations with different pacing sites and prevention approaches

“…BB pacing results in significantly lower P-wave duration compared with RAA pacing ( 36 ) ( Figure 3 ). Furthermore, BB pacing restore atrial synchrony and often provides a more physiological atrial contraction sequence ( 37 ).…”