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Background <p>Physiological pacing of the atrium, specifically targeting the Bachmann bundle area (BBA), has been associated with improved interatrial conduction and reduced atrial arrhythmia risk. The Bachmann bundle (BB) is the principal interatrial conduction tract, yet its electrophysiological definition in humans remains incompletely characterized. This study aimed to describe the electrogram features of the BBA using 3D electroanatomical-mapping (EAM) with peak-frequency (PF) analysis during atrial lead implantation.</p> Methods <p>All patients undergoing dual-chamber pacemaker implantation with the atrial lead positioned in the BBA were included. Right atrial mapping was performed using either a quadripolar or the HD Grid catheter. PF maps were created and PFs at the targeted site were measured before and after lead positioning. Procedural parameters, P-wave duration (PWD) and pacing thresholds were analyzed.</p> Results <p>Twelve consecutive patients undergoing dual-chamber pacemaker implantation with the atrial lead positioned in the (BBA) were prospectively studied. The optimal PF band for BBA localization was 400–500 Hz (AUC = 0.83, sensitivity 87%, specificity 80%). Lead fixation was associated with a reproducible PF decrease, which correlated with P-wave shortening (<i>r</i> = –0.66, <i>p</i> = 0.02). Lower PF values (&lt; 400 Hz) after lead fixation were associated with effective P-wave narrowing. No complications occurred. At three-month follow-up, all leads remained stable with normal pacing parameters.</p> Conclusion <p>This study provides a characterization of the human Bachmann bundle region using 3D mapping. High PF electrograms distinguish the BBA from adjacent atrial tissue, while PF reductions during fixation correlate with improved P-wave shortening.</p> Graphical abstract <p>Peak-frequency and electrogram analysis using 3D mapping provided a distinct electrophysiological signature of the human Bachmann bundle region. Pre-implant PF values around 400–500&#xa0;Hz correlated with favorable pacing thresholds, while lower PF values (&lt; 400&#xa0;Hz) observed after lead screwing were associated with effective P-wave narrowing.</p> <p></p>

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Electrophysiological characterization of the Bachmann bundle region using 3D electroanatomical mapping and peak frequency analysis during pacemaker lead implantation

  • 期刊论文

  • 发表日期：

    2026年7月10日

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  • Ingrid Overeinder,
  • Luigi Pannone,
  • Ivan Eltsov,
  • Neal Duong,
  • Domenico Laviola,
  • Ioannis Doundoulakis,
  • Domenico Giovanni Della Rocca,
  • Paul-Adrian Calburean,
  • Vedran Pašara,
  • Ludovica Carmagnola,
  • Tommaso Sattin,
  • Luca Canovi,
  • Antonio Sorgente,
  • Alvise Del Monte,
  • Giacomo Talevi,
  • Gezim Bala,
  • Alexandre Almorad,
  • Erwin Ströker,
  • Juan Sieira,
  • Ali Gharaviri,
  • Mark La Meir,
  • Pedro Brugada,
  • Andrea Sarkozy,
  • Gian Battista Chierchia,
  • Paul A. Iaizzo,
  • Carlo de Asmundis

摘要

Background

Physiological pacing of the atrium, specifically targeting the Bachmann bundle area (BBA), has been associated with improved interatrial conduction and reduced atrial arrhythmia risk. The Bachmann bundle (BB) is the principal interatrial conduction tract, yet its electrophysiological definition in humans remains incompletely characterized. This study aimed to describe the electrogram features of the BBA using 3D electroanatomical-mapping (EAM) with peak-frequency (PF) analysis during atrial lead implantation.

Methods

All patients undergoing dual-chamber pacemaker implantation with the atrial lead positioned in the BBA were included. Right atrial mapping was performed using either a quadripolar or the HD Grid catheter. PF maps were created and PFs at the targeted site were measured before and after lead positioning. Procedural parameters, P-wave duration (PWD) and pacing thresholds were analyzed.

Results

Twelve consecutive patients undergoing dual-chamber pacemaker implantation with the atrial lead positioned in the (BBA) were prospectively studied. The optimal PF band for BBA localization was 400–500 Hz (AUC = 0.83, sensitivity 87%, specificity 80%). Lead fixation was associated with a reproducible PF decrease, which correlated with P-wave shortening (r = –0.66, p = 0.02). Lower PF values (< 400 Hz) after lead fixation were associated with effective P-wave narrowing. No complications occurred. At three-month follow-up, all leads remained stable with normal pacing parameters.

Conclusion

This study provides a characterization of the human Bachmann bundle region using 3D mapping. High PF electrograms distinguish the BBA from adjacent atrial tissue, while PF reductions during fixation correlate with improved P-wave shortening.

Graphical abstract

Peak-frequency and electrogram analysis using 3D mapping provided a distinct electrophysiological signature of the human Bachmann bundle region. Pre-implant PF values around 400–500 Hz correlated with favorable pacing thresholds, while lower PF values (< 400 Hz) observed after lead screwing were associated with effective P-wave narrowing.