Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Physiology D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-043 - Bachmann Bundle Pacing Is Associated With Decreased Atrial Arrhythmia Burden And Progression Over Time (ID 894)

 M. Infeld: Nothing relevant to disclose.
Audio File Upload


Background: Bachmann Bundle (BB) pacing restores interatrial conduction, but data showing a clinical benefit has been inconsistent.
Objective: Compare AF/AT burden over time between anatomic lead positioning in the high right atrial septum (RAS) versus electrically guided BB pacing.
Methods: We identified patients with RAS leads (n=792) placed at our institution from 2008-2018. Subjects with RAS pacing ≥20% and regular follow up were included. BB pacing criteria were based on p-wave duration (PWD), morphology, and fluoroscopic position. AF/AT burden was obtained as the percentage of time per day in AF/AT on PPM device reports. Difference in AF/AT burden was compared between groups at pre-specified time points using repeated measures ANOVA and controlling for significant confounders.
Results: In the BB group (n=95) [median age 71, sinus PWD 150ms, paced PWD 115ms; mean 63 +/- 21% RAS pacing; 38% female] mean AF/AT burden decreased from 3.4 +/-18% at 3 months (mos) to 1.5 +/-7% at 24 mos. In the non BB group (n=83) [median: age 77, sinus PWD 140ms, paced PWD 144ms; mean 63 +/- 26% RAS pacing; 29% female] mean AF/AT burden increased over time from 2.3 +/- 7% at 3 mos to 7 +/-21% at 24 mos. Atrial lead parameters, rates of cardioversion, anti-arrhythmic drug use, and AF/AT ablation were similar between groups. Paced PWD was shorter in the BB group (p<0.01). AF/AT burden was lower in BB (0.3 +/- 1%) than non BB (4.9 +/-18%) at 12-15 mos (p=0.02) and 24-27 mos (1.5 +/- 7% vs 7 +/- 21%; p=0.03).
Conclusion: Anatomic lead position in the high RAS needs to be coupled with normalization of P wave morphology and duration to attenuate AF/AT burden and progression over time.