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Bachmann’s 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 observed that differences in the speed of atrial impulse propagation are influenced by myofiber orientation.
      • Lewis T.
      • Meakins J.
      • White D.
      The excitatory process in the dog’s heart.
      Two years later Jean George Bachmann 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’s bundle (BB).
      • Bachmann J.G.
      The interauricular time interval.
      Damage to BB results in interatrial conduction delay (IACD) manifesting as prolonged P-wave duration (PWD) >120 milliseconds (ms) on the surface electrocardiograph (ECG).
      • 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.
      Bachmann’s bundle 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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