Leadless Atrial Pacing Targeting Bachmann's Bundle for Atrial Resynchronization.

Background: Leadless pacemakers have transformed pacing by reducing risk for infection and lead-related complications. The feasibility of achieving leadless Bachmann's bundle area pacing (BBAP) for atrial resynchronization is not known.

First-in-human Summary: A 49-year-old woman with sinus node dysfunction and interatrial conduction delay underwent leadless atrial pacemaker targeting Bachmann's bundle (BB). Using intracardiac echocardiography and electrographic mapping, the pacemaker was positioned at the BB region. Reduced right atrium-to-lateral left atrium conduction time and paced P wave duration were confirmed.

Discussion: Right atrial appendage pacing may exacerbate interatrial conduction delay and promote atrial fibrillation. BBAP using a leadless atrial pacemaker, in contrast, has been shown to enhance atrial synchrony.

Novelty: This case demonstrates the first-in-human permanent implantation of a leadless pacemaker in the BB area, providing a strategy for leadless atrial resynchronization.

Take-home Message: Leadless BBAP may offer a physiological approach to atrial conduction system pacing by improving atrioventricular dromotropy and reducing subsequent risk for atrial fibrillation.