Bachmann bundle area pacing in Korea: High procedural success and stable mid-term lead performance in a two-center cohort

초록

Background Bachmann bundle area pacing (BBAP) is an emerging physiological atrial pacing strategy. However, real-world data from Asian populations remains limited. Objective To evaluate feasibility, safety, and mid-term lead performance of BBAP in a Korean 2-center cohort. Methods This retrospective study included consecutive patients who underwent BBAP between December 2024 and March 2026. Procedural success was defined by prespecified paced P-wave morphology criteria. Baseline characteristics, procedural findings, and serial atrial lead parameters over 6 months were analyzed. Results Among 112 patients (median age 73 years; 42.9% male), BBAP was successfully achieved in 101 (90.2%). Compared with patients with successful BBAP, those with unsuccessful BBAP were older (median 79 vs 73 years, P = .018), were more frequently male (72.7% vs 39.6%, P = .036), had a longer P-wave duration (PWD) (median 140 ms vs 121 ms, P = .022), and had a lower left ventricular ejection fraction (median 59% vs 63%, P = .046). Paced PWD was significantly shorter in successful cases than baseline sinus PWD (100 ms [interquartile range, 88–112] vs 121 ms [interquartile range, 110–130]; P < .001). Over 6 months, lead performance remained stable, with decreasing impedance (from 703 to 589 Ω; P -for-trend < .001), preserved sensing amplitude (from 1.6 to 1.9 mV; P -for-trend = .141), and no significant overall change in pacing threshold (from 0.75 to 0.81 V; overall P = .066). Only 1 lead dislodgement (1.0%) and 3 significant threshold rises (3.0%) occurred. Conclusion In this initial Korean 2-center experience, BBAP showed high procedural success, acceptable safety, and stable mid-term lead performance. Older age and lower ejection fraction were associated with procedural failure. © 2026 Heart Rhythm Society.

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