3D electroanatomical mapping identified the optimal peak frequency band for Bachmann bundle area localization as 400–500 Hz (AUC=0.83), and PF reductions correlated with P-wave shortening (r=-0.66, P=0.02).
Observational (n=12)
Does 3D electroanatomical mapping with peak-frequency analysis accurately characterize the Bachmann bundle area during pacemaker lead implantation?
3D electroanatomical mapping with peak-frequency analysis can identify the Bachmann bundle area (optimal band 400-500 Hz) and correlates lead fixation with P-wave shortening, potentially guiding physiological atrial pacing.
Effect estimate: AUC 0.83; r = -0.66
p-value: p=0.02
Background Physiological pacing of the atrium, specifically targeting the Bachmann bundle area (BBA), has been associated with improved interatrial conduction and reduced atrial arrhythmia risk. The Bachmann bundle (BB) is the principal interatrial conduction tract, yet its electrophysiological definition in humans remains incompletely characterized. This study aimed to describe the electrogram features of the BBA using 3D electroanatomical-mapping (EAM) with peak-frequency (PF) analysis during atrial lead implantation. Methods All patients undergoing dual-chamber pacemaker implantation with the atrial lead positioned in the BBA were included. Right atrial mapping was performed using either a quadripolar or the HD Grid catheter. PF maps were created and PFs at the targeted site were measured before and after lead positioning. Procedural parameters, P-wave duration (PWD) and pacing thresholds were analyzed. Results Twelve consecutive patients undergoing dual-chamber pacemaker implantation with the atrial lead positioned in the (BBA) were prospectively studied. The optimal PF band for BBA localization was 400–500 Hz (AUC = 0.83, sensitivity 87%, specificity 80%). Lead fixation was associated with a reproducible PF decrease, which correlated with P-wave shortening (r = –0.66, p = 0.02). Lower PF values (< 400 Hz) after lead fixation were associated with effective P-wave narrowing. No complications occurred. At three-month follow-up, all leads remained stable with normal pacing parameters. Conclusion This study provides a characterization of the human Bachmann bundle region using 3D mapping. High PF electrograms distinguish the BBA from adjacent atrial tissue, while PF reductions during fixation correlate with improved P-wave shortening. Graphical abstract Peak-frequency and electrogram analysis using 3D mapping provided a distinct electrophysiological signature of the human Bachmann bundle region. Pre-implant PF values around 400–500 Hz correlated with favorable pacing thresholds, while lower PF values (< 400 Hz) observed after lead screwing were associated with effective P-wave narrowing.
Overeinder et al. (Fri,) conducted a observational in Dual-chamber pacemaker implantation (n=12). 3D electroanatomical mapping and peak frequency analysis was evaluated on Optimal peak frequency band for Bachmann bundle area localization and correlation with P-wave shortening (AUC 0.83; r = -0.66, p=0.02). 3D electroanatomical mapping identified the optimal peak frequency band for Bachmann bundle area localization as 400–500 Hz (AUC=0.83), and PF reductions correlated with P-wave shortening (r=-0.66, P=0.02).