Why is it reasonable to pace the Bachmann's bundle? Electrocardiographic and clinical considerations
Abstract
Despite its widely-understood physiological mode, artificial atrial pacing can negatively influence heart performance in
many respects. We present the case of an 80-year-old woman with the signs and symptoms of diastolic heart failure which
had originated, according to the patient herself, due to the implantation of a dual chamber pacemaker inserted for the
treatment of sinus node disease. The atrial electrode was located in the right atrial appendage. Electrocardiographic and
echocardiographic assessment indicated the possibility of a deleterious relationship between the atrial and ventricular
contraction, which could be responsible for patient’s symptoms. Some changes in device programming could contribute to
a clinical improvement. Yet the question remains: should pacing of the Bachmann’s bundle be implemented in our patient?
Keywords: atrial pacingBachmann’s bundle pacingdiastolic heart failure
References
- Braunwald E, Bonow RO. Braunwald's heart disease: a textbook of cardiovascular medicine. Elsevier Saunders, Philadelphia: 2012.
- Rein AJ, O'Donnell CP, Colan SD, et al. Tissue velocity Doppler assessment of atrial and ventricular electromechanical coupling and atrioventricular time intervals in normal subjects. Am J Cardiol. 2003; 92(11): 1347–1350.
- Wang K, Xiao HB, Fujimoto S, et al. Atrial electromechanical sequence in normal subjects and patients with DDD pacemakers. Br Heart J. 1995; 74(4): 403–407.
- Bąkowski D, Wożakowska-Kapłon B. Blok przedsionkowo-komorowy I stopnia u chorego z dwujamowym kardiowerterem-defibrylatorem — pozornie błahy problem. Folia Cardiol. 2016; 11(1): 75–79.
- Eicher JC, Laurent G, Mathé A, et al. Atrial dyssynchrony syndrome: an overlooked phenomenon and a potential cause of 'diastolic' heart failure. Eur J Heart Fail. 2012; 14(3): 248–258.
- Kliś M, Sławuta A, Gajek J. Antiarrhythmic properties of atrial pacing. Adv Clin Exp Med. 2017; 26(2): 351–357.
- Miyazaki H, Noma K, Date T, et al. Atrial septal pacing to resynchronize atrial contraction and improve atrial transport function. J Cardiol. 2005; 45(6): 239–246.
- Bailin SJ, Adler S, Giudici M. Prevention of chronic atrial fibrillation by pacing in the region of Bachmann's bundle: results of a multicenter randomized trial. J Cardiovasc Electrophysiol. 2001; 12(8): 912–917.
- Kristensen L, Nielsen JC, Mortensen PT, et al. Sinus and paced P wave duration and dispersion as predictors of atrial fibrillation after pacemaker implantation in patients with isolated sick sinus syndrome. Pacing Clin Electrophysiol. 2004; 27(5): 606–614.
- Sławuta A, Kliś M, Skoczyński P, et al. Bachmann's bundle pacing not only improves interatrial conduction but also reduces the need for ventricular pacing. Adv Clin Exp Med. 2016; 25(5): 845–850.
