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Physiological atrial pacing via the Bachmann bundle: first experience in a tertiary care centre
Session:
Prémio Melhor Comunicação Oral
Speaker:
Maria João de Brito Mesquita Belo e Primo
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.1 Antibradycardia Pacing
Session Type:
Sessão de Prémios
FP Number:
---
Authors:
Maria João Primo; João André Ferreira; Natália António; Patrícia Alves; Carolina Saleiro; Didier Martinez; Rita Bertão Ventura; Inês Brito e Cruz; Pedro Sousa; Lino Gonçalves
Abstract
<p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Introduction and objectives:<br /> Bachmann bundle pacing (BBP) is an emerging physiological atrial pacing technique designed to enhance interatrial conduction and potentially reduce atrial arrhythmias. Despite increasing interest, real-world data on procedural performance, electrical stability, and atrial activation metrics remain limited. This study reports the first experience of BBP in a tertiary centre, with detailed procedural and follow-up assessment.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Methods:<br /> We conducted a prospective single-centre observational registry including consecutive patients undergoing BBP between December 2024 and October 2025. Procedural characteristics (pacing threshold, sensing amplitude, impedance, fluoroscopy time, and procedure duration) and follow-up parameters were recorded at hospital discharge and subsequent visits. P-wave duration was measured before and after BBP to evaluate interatrial activation changes. Continuous variables are presented as mean, median, interquartile range (IQR), and standard deviation (SD).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Results:<br /> A total of 30 patients underwent BBP. At implantation, mean pacing threshold was 1.14 V (median 1.0 V, IQR 0.79–1.35; SD 0.54), and mean sensing amplitude was 2.16 mV (median 1.5 mV, IQR 1.05–2.40; SD 2.63). Median fluoroscopy time was 11.2 minutes (8.7–15.4), and procedure duration showed a median of 88.5 minutes (IQR 73.0–108.5).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">At first follow-up, mean pacing threshold decreased to 0.59 V (SD 0.36). Sensing amplitude remained stable at 2.46 mV (SD 2.30), and impedance values were preserved (mean 623 Ω, IQR 456–713; SD 240). No major complications (e.g. dislodgement) occurred. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">BBP produced a significant shortening of P-wave duration (mean reduction −25.6 ms; p = 0.0003), indicating improved interatrial conduction.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Conclusions:<br /> In this first real-world experience, BBP implantation was feasible with excellent acute electrical performance, stable follow-up parameters, and low complication rates. The significant reduction in P-wave duration supports BBP as a promising physiological atrial pacing strategy capable of improving interatrial conduction. Larger prospective studies are warranted to confirm long-term clinical and electrophysiological benefits.</span></span></p>
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