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Bachmann bundle potential during atrial lead placement: A case series

Published:November 11, 2021DOI:https://doi.org/10.1016/j.hrthm.2021.11.015
      In 1914 Sir Thomas Lewis
      • Lewis T.
      • Meakins J.
      • White D.
      The excitatory process in the dog’s heart.
      observed that differences in the speed of atrial impulse propagation are influenced by myofiber orientation. Two years later Jean George Bachmann
      • Bachmann J.G.
      The interauricular time interval.
      reported that left atrial (LA) activation occurs primarily over a muscular band of longitudinally arranged fibers immediately adjacent to the crista terminalis (CT), which became known as Bachmann bundle (BB). Damage to BB results in interatrial conduction delay (IACD) manifesting as prolonged P-wave duration (PWD) > 120 ms on the surface electrocardiogram.
      • Bachmann J.G.
      The interauricular time interval.
      ,
      • Waldo A.L.
      • Bush H.L.
      • Gelband H.
      • et al.
      Effects on the canine P-wave of discrete lesions in the specialized atrial tracts.
      Prolonged PWD is associated with atrial electromechanical dysfunction
      • Goyal S.B.
      • Spodick D.H.
      Electromechanical dysfunction of the left atrium associated with interatrial block.
      and the development of atrial fibrillation (AF).
      • Agarwal Y.K.
      • Aronow W.S.
      • Levy J.A.
      • Spodick D.H.
      Association of interatrial block with development of atrial fibrillation.
      BB pacing (BBp) shortens interatrial conduction time
      • Roithinger F.X.
      • Abou-Harb M.
      • Pachinger O.
      • Hintringer F.
      The effect of the atrial pacing site on the total atrial activation time.
      and reduces atrial dyssynchrony by restoring atrial activation sequences elicited by the sinus node.
      • Lewis T.
      • Meakins J.
      • White D.
      The excitatory process in the dog’s heart.
      • Bachmann J.G.
      The interauricular time interval.
      • Waldo A.L.
      • Bush H.L.
      • Gelband H.
      • et al.
      Effects on the canine P-wave of discrete lesions in the specialized atrial tracts.
      • Goyal S.B.
      • Spodick D.H.
      Electromechanical dysfunction of the left atrium associated with interatrial block.
      In 2001 Bailin et al
      • Bailin S.J.
      • Adler S.
      • Giudici M.
      Prevention of chronic atrial fibrillation by pacing in the region of Bachmann’s bundle: results of a multicenter randomized trial.
      published the only multicenter randomized controlled trial specifically focused on BBp, comparing it with traditional right atrial appendage pacing (RAAp). In that study, BBp was associated with a significant reduction in the rate of progression to chronic AF.
      • Bailin S.J.
      • Adler S.
      • Giudici M.
      Prevention of chronic atrial fibrillation by pacing in the region of Bachmann’s bundle: results of a multicenter randomized trial.

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