Arrhythmias & electrophysiology
Output-dependent electrocardiographic criteria to distinguish Bachmann bundle area pacing from high atrial septal pacing: Validation with coronary sinus mapping
Authors' conclusion
Output-dependent ECG transition, particularly changes in P-wave morphology, Stim-PWPTII, and CS activation timing, provides practical and reproducible intraprocedural markers of preferential interatrial conduction. These findings represent physiologic evidence rather than definitive proof of direct Bachmann bundle capture.
Study context
- Population
- Patients undergoing attempted Bachmann bundle area pacingpatients undergoing attempted bachmann bundle area pacing (BBAP)
- Participants
- Fifty-seven patients
- Exposure
- BBAP vs high atrial septal pacing (HASP) without abrupt transition
- Outcome
- Abrupt output-dependent P-wave morphology transitions
Methodological detailsvalidation with coronary sinus mapping
- Validation with coronary sinus mapping
Main finding
As reported in the abstract
Abrupt output-dependent P-wave morphology transitions
41 of 57 patients
71.9%
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| PWD, Stim-PWPTII and Stim-CSd intervalsShorter with BBAP | all P < .001 |
Final pacing site with physiologic markers consistent with BBAP after mapping-guided lead repositioning
- Final pacing site consistent with BBAP
- 56 of 57 patients (98.2%)
ΔStim-PWPTII of ≥10 milliseconds
- Consistently separated the study-defined BBAP and HASP groups within this cohort
- Should be considered hypothesis-generating and requires prospective validation
Original publication
Output-dependent electrocardiographic criteria to distinguish Bachmann bundle area pacing from high atrial septal pacing: Validation with coronary sinus mapping. Heart Rhythm. Published 3 August 2026. doi:10.
Summarised from the published abstract; every number is checked against it