Bachmann bundle pacing in ICD recipients: a pilot study on atrial function and hemodynamic benefits

Background Implantable cardioverter-defibrillator (ICD) therapy is essential for preventing sudden cardiac death (SCD) in patients with heart failure (HF). Although the right atrial appendage (RAA) is the conventional site for atrial lead placement, RAA pacing may prolong P-wave duration and promote atrial fibrillation (AF), particularly in patients with atrial cardiomyopathy or conduction delay. Bachmann’s bundle pacing (BBP) has been reported to improve interatrial conduction and left atrial function. We applied BBP during ICD implantation (BBP-ICD) to evaluate its effects on atrial and hemodynamic function. Methods Fourteen ICD recipients (any indication) underwent atrial lead placement at the Bachmann’s bundle region to achieve BBP. Clinical improvement was assessed from outpatient symptom records, and echocardiographic follow-up was obtained when available. Results BBP was successfully achieved in all patients with consistent shortening of paced P-wave duration. Among those presenting with exertional dyspnea (7/12, 58.3%), all showed symptomatic improvement after BBP-ICD (7/7, p < 0.005). Left atrial volume (LAV, LAVI) significantly decreased (p = 0.006), and diastolic function, represented by E/e’, showed a trend toward improvement (p = 0.317). Detailed data are presented in the table and figure. Conclusion Beyond its role in preventing SCD, ICD therapy incorporating BBP may provide additional benefits in patients with HF by improving atrial conduction, diastolic function, and exercise tolerance. This pilot experience suggests the potential for dual-chamber ICDs with BBP to support both rhythm stabilization and hemodynamic optimization. Further multicenter, randomized studies are warranted.