Is Bachmann's Bundle the only right site for single-site pacing to prevent atrial fibrillation? Results of a multicenter randomized trial.

The site of atrial pacing influences atrial activation patterns. It is believed that disparities in atrial activation and repolarization are contributors to the development and recurrence of atrial arrhythmias. We hypothesized that pacing from Bachmann's Bundle would improve clinical outcomes in patients with paroxysmal atrial fibrillation compared to right atrial appendage pacing. Pacing from Bachmann's Bundle results in a significant reduction in P wave duration and improvement in biatrial activation symmetry compared to right atrial appendage pacing. Compared to right atrial appendage pacing, Bachmann's bundle pacing improves sinus rhythm (75% vs. 47% at two years, p < 0.01) in patients with a history of paroxysmal atrial fibrillation. Recent studies have confirmed the benefits of Bachmann's Bundle pacing on atrial activation and rhythm regulation. Thus, Bachman's Bundle should be considered the preferred site for atrial pacing in patients with a history of paroxysmal atrial fibrillation.