Bachmann's Bundle Area Pacing in Korea: High Procedural Success and Stable Mid-Term Lead Performance in a Two-Center Cohort

Background Bachmann's bundle area pacing (BBAP) is an emerging physiological atrial pacing strategy. However, real-world data from Asian populations remains limited. Objective To evaluate feasibility, safety, and mid-term lead performance of BBAP in a Korean two-center cohort. Methods This retrospective study included consecutive patients who underwent BBAP between December 2024 and March 2026. Procedural success was defined by prespecified paced P-wave morphology criteria. Baseline characteristics, procedural findings, and serial atrial lead parameters over 6 months were analyzed. Results Among 112 patients (median age 73 years; 42.9% male), BBAP was successfully achieved in 101 (90.2%). Compared with patients with successful BBAP, those with unsuccessful BBAP were older (median 79 vs. 73 years, p=0.018), were more frequently male (72.7% vs. 39.6%, p=0.036), had a longer P-wave duration (median 140 ms vs. 121 ms, p=0.022), and had a lower left ventricular ejection fraction (median 59% vs. 63%, p=0.046). In successful cases, paced P-wave duration was significantly shorter than baseline sinus P-wave duration (100 ms [IQR 88–112] vs 121 ms [IQR 110–130]; p<0.001). Over 6 months, lead performance remained stable, with decreasing impedance (703 to 589 Ω; p-for-trend <0.001), preserved sensing amplitude (1.6 to 1.9 mV; p-for-trend=0.141), and no significant overall change in pacing threshold (0.75 to 0.81 V; overall p=0.066). Only 1 lead dislodgement (1.0%) and 3 significant threshold rises (3.0%) occurred. Conclusion In this initial Korean two-center experience, BBAP showed high procedural success, acceptable safety, and stable mid-term lead performance. Older age and lower ejection fraction were associated with procedural failure.