Key result
Bachmann's bundle leadless atrial pacing shortens interatrial conduction time and paced P-wave duration.
Why the study?
The feasibility of achieving leadless Bachmann's bundle area pacing for atrial resynchronization was not known.
Does leadless atrial pacing targeting Bachmann's bundle improve atrial resynchronization in a patient with sinus node dysfunction and interatrial conduction delay?
Case Report (n=1)
Does leadless atrial pacing targeting Bachmann's bundle improve atrial resynchronization in a patient with sinus node dysfunction and interatrial conduction delay?
This first-in-human case demonstrates the feasibility of leadless Bachmann's bundle area pacing to achieve atrial resynchronization, potentially offering a more physiological approach than traditional right atrial appendage pacing.
Answers are grounded in this paper and cite their sources.
Feasibility of leadless BBAP in one case is hypothesis-generating; leaves open efficacy, safety, and role in atrial resynchronization.
BACKGROUND: Leadless pacemakers have transformed pacing by reducing risk for infection and lead-related complications. The feasibility of achieving leadless Bachmann's bundle area pacing (BBAP) for atrial resynchronization is not known. FIRST-IN-HUMAN SUMMARY: A 49-year-old woman with sinus node dysfunction and interatrial conduction delay underwent leadless atrial pacemaker targeting Bachmann's bundle (BB). Using intracardiac echocardiography and electrographic mapping, the pacemaker was positioned at the BB region. Reduced right atrium-to-lateral left atrium conduction time and paced P wave duration were confirmed. DISCUSSION: Right atrial appendage pacing may exacerbate interatrial conduction delay and promote atrial fibrillation. BBAP using a leadless atrial pacemaker, in contrast, has been shown to enhance atrial synchrony. NOVELTY: This case demonstrates the first-in-human permanent implantation of a leadless pacemaker in the BB area, providing a strategy for leadless atrial resynchronization. TAKE-HOME MESSAGE: Leadless BBAP may offer a physiological approach to atrial conduction system pacing by improving atrioventricular dromotropy and reducing subsequent risk for atrial fibrillation.
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Hollis et al. (2025) conducted a case report in Sinus node dysfunction and interatrial conduction delay (n=1). Leadless atrial pacemaker targeting Bachmann's bundle was evaluated on Right atrium-to-lateral left atrium conduction time and paced P wave duration. Leadless atrial pacing targeting Bachmann's bundle was successfully implanted in a 49-year-old woman, reducing right atrium-to-lateral left atrium conduction time and paced P wave duration.
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