What is the clinical evidence from this study?

Study design: Cohort. Population: Patients undergoing electrophysiology study and ablation or Bachmann bundle pacing lead implantation (n=100). Intervention: Non-invasive assessment using lead V8 vs. Invasive coronary sinus catheter assessment. Primary outcome: Correlation between NDAT-P-V8 and latest coronary sinus activation (r = 0.94, p=<0.001).

What does this research mean for the field?

ECG lead V8 steepest negative downslope of the P-wave (NDAT-P-V8) accurately reflects posterolateral left atrial activation timing and provides a reliable non-invasive method to assess left atrial resynchronization during Bachmann bundle pacing. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate whether ECG lead V8 reflects posterolateral left atrial activation time and can non-invasively assess the synchronization effects of Bachmann bundle pacing.

September 28, 2026EP EuropaceOpen Access

Non-invasive assessment of left atrial activation using lead V8 during Bachmann bundle pacing

Q: What are the key findings of this study?

Non-invasive assessment of left atrial activation using lead V8 strongly correlated with invasive timing (r=0.94, p<0.001) and detected activation shortening during Bachmann bundle pacing.

Q: What does this research mean for the field?

ECG lead V8 steepest negative downslope of the P-wave (NDAT-P-V8) accurately reflects posterolateral left atrial activation timing and provides a reliable non-invasive method to assess left atrial resynchronization during Bachmann bundle pacing. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate whether ECG lead V8 reflects posterolateral left atrial activation time and can non-invasively assess the synchronization effects of Bachmann bundle pacing.

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Key result

Non-invasive lead V8 achieves a 0.94 correlation with invasive left atrial activation timing.

r = 0.94
P<0.001
n=100

Why the study?

Quantifying inter-atrial synchronization during Bachmann bundle pacing remains challenging, necessitating a non-invasive method to assess left atrial activation.

Does surface ECG lead V8 accurately reflect posterolateral left atrial activation time and assess the effect of Bachmann bundle pacing?

Comparison

Lead V8 ECG assessment vs invasive coronary sinus catheter activation timing and baseline pre-pacing parameters

Design

Prospective cohort study

Authors

SMSimon MulierMaastricht University Medical Centre AFArno FennemaUtrecht University JKJohan van KollElectrophysiology

Discussion

Member takes

Implication

May support V8 as non-invasive LA activation marker; extends Bachmann bundle observations but leaves open outcome benefits in prospective trials.

Key Points

To evaluate whether ECG lead V8 reflects posterolateral left atrial activation time and can non-invasively assess the synchronization effects of Bachmann bundle pacing.
Prospectively enrolled consecutive patients undergoing electrophysiology study and ablation (Cohort 1, n=50) or Bachmann bundle pacing lead implantation (Cohort 2, n=50).
Recorded surface ECGs with the V5 electrode moved to position V8 (2 cm below the inferior left scapula) to measure the P-wave steepest negative downslope (NDAT-P-V8) and iso-V8 interval.
Validated NDAT-P-V8 against invasive coronary sinus catheter activation times in Cohort 1 and evaluated pacing-induced changes in Cohort 2.
In Cohort 1 (n=50), NDAT-P-V8 strongly correlated with the latest coronary sinus activation time measured invasively (r = 0.94, p < 0.001).
In Cohort 2 (n=50), Bachmann bundle pacing corrected interatrial block in 87% of affected patients (20/23).
Bachmann bundle pacing significantly shortened NDAT-P-V8 (from 120±25 ms to 82±17 ms, p < 0.001) and iso-V8 (from 51±22 ms to 18±17 ms, p < 0.001), demonstrating earlier left atrial activation.

Study Design

Type

Cohort (n=100)

Structured PICO

Does surface ECG lead V8 accurately reflect posterolateral left atrial activation time and assess the effect of Bachmann bundle pacing?

Population

100 consecutive patients undergoing an electrophysiology study and ablation or Bachmann bundle pacing lead implantation.

Exposure

Surface ECG recording using lead V8 (V5 electrode repositioned 2 cm below the inferior left scapula) to determine left atrial activation via the steepest negative downslope of the P-wave (NDAT-P-V8) and iso-V8.

Comparator

Invasive activation timing at the posterolateral left atrium using a coronary sinus catheter (Cohort 1); baseline pre-pacing parameters (Cohort 2).

Outcome

Correlation of NDAT-P-V8 with latest coronary sinus activation (Cohort 1) and change in NDAT-P-V8 and iso-V8 during Bachmann bundle pacing (Cohort 2).surrogate

Main Result

Effect estimate: r = 0.94

p-value: p=<0.001

Lead V8 provides a simple, non-invasive marker that closely reflects invasive posterolateral left atrial activation timing and can be used to assess and optimize atrial activation during Bachmann bundle pacing.

Cite This Study

Mulier et al. (2026) conducted a cohort in Patients undergoing electrophysiology study and ablation or Bachmann bundle pacing lead implantation (n=100). Non-invasive assessment using lead V8 vs. Invasive coronary sinus catheter assessment was evaluated on Correlation between NDAT-P-V8 and latest coronary sinus activation (r = 0.94, p=<0.001). Non-invasive assessment of left atrial activation using lead V8 strongly correlated with invasive timing (r=0.94, p<0.001) and detected activation shortening during Bachmann bundle pacing.

synapsesocial.com/papers/6ab9b5067822ec8fc3d8f5db https://doi.org/10.1093/europace/euag276

Topics

AF ablation outcomes

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September 28, 2026EP EuropaceOpen Access

Non-invasive assessment of left atrial activation using lead V8 during Bachmann bundle pacing

View Full Paper

Ask AI

Bookmark

Key result

Non-invasive lead V8 achieves a 0.94 correlation with invasive left atrial activation timing.

r = 0.94
P<0.001
n=100

Why the study?

Quantifying inter-atrial synchronization during Bachmann bundle pacing remains challenging, necessitating a non-invasive method to assess left atrial activation.

Does surface ECG lead V8 accurately reflect posterolateral left atrial activation time and assess the effect of Bachmann bundle pacing?

Comparison

Lead V8 ECG assessment vs invasive coronary sinus catheter activation timing and baseline pre-pacing parameters

Design

Prospective cohort study

Authors

SMSimon MulierMaastricht University Medical Centre AFArno FennemaUtrecht University JKJohan van KollElectrophysiology

Discussion

Member takes

Implication

May support V8 as non-invasive LA activation marker; extends Bachmann bundle observations but leaves open outcome benefits in prospective trials.

Key Points

To evaluate whether ECG lead V8 reflects posterolateral left atrial activation time and can non-invasively assess the synchronization effects of Bachmann bundle pacing.
Prospectively enrolled consecutive patients undergoing electrophysiology study and ablation (Cohort 1, n=50) or Bachmann bundle pacing lead implantation (Cohort 2, n=50).
Recorded surface ECGs with the V5 electrode moved to position V8 (2 cm below the inferior left scapula) to measure the P-wave steepest negative downslope (NDAT-P-V8) and iso-V8 interval.
Validated NDAT-P-V8 against invasive coronary sinus catheter activation times in Cohort 1 and evaluated pacing-induced changes in Cohort 2.
In Cohort 1 (n=50), NDAT-P-V8 strongly correlated with the latest coronary sinus activation time measured invasively (r = 0.94, p < 0.001).
In Cohort 2 (n=50), Bachmann bundle pacing corrected interatrial block in 87% of affected patients (20/23).
Bachmann bundle pacing significantly shortened NDAT-P-V8 (from 120±25 ms to 82±17 ms, p < 0.001) and iso-V8 (from 51±22 ms to 18±17 ms, p < 0.001), demonstrating earlier left atrial activation.

Study Design

Type

Cohort (n=100)

Structured PICO

Does surface ECG lead V8 accurately reflect posterolateral left atrial activation time and assess the effect of Bachmann bundle pacing?

Population

100 consecutive patients undergoing an electrophysiology study and ablation or Bachmann bundle pacing lead implantation.

Exposure

Comparator

Invasive activation timing at the posterolateral left atrium using a coronary sinus catheter (Cohort 1); baseline pre-pacing parameters (Cohort 2).

Outcome

Correlation of NDAT-P-V8 with latest coronary sinus activation (Cohort 1) and change in NDAT-P-V8 and iso-V8 during Bachmann bundle pacing (Cohort 2).surrogate

Main Result

Effect estimate: r = 0.94

p-value: p=<0.001

Cite This Study

synapsesocial.com/papers/6ab9b5067822ec8fc3d8f5db https://doi.org/10.1093/europace/euag276

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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AF ablation outcomes

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