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Bachmann bundle pacing reduces atrial electromechanical delay in type 1 myotonic dystrophy patients

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Atrial electromechanical delay (AEMD) is an echocardiographic parameter correlated with the onset of supraventricular arrhythmias in several clinical conditions. Inter-atrial septal pacing in the region of Bachmann’s bundle (BB) has been shown to be safe and feasible in myotonic dystrophy type 1 (DM1) patients, with a low rate of sensing and pacing defects. The aim of this study was to assess the impact of temporary BB pacing compared with right atrial appendage (RAA) pacing on AEMD in DM1 patients undergoing pacemaker (PM) implantation for cardiac rhythm abnormalities.

Methods

The study enrolled 70 consecutive DM1 patients undergoing PM implantation for cardiac rhythm abnormalities in accordance with the current guidelines. Seventy age- and sex-matched non-DM1 patients undergoing dual-chamber PM implantation for cardiac rhythm abnormalities were used as controls. The atrial pacing lead was temporarily positioned in the RAA and on the right side of the inter-atrial septum in the region of Bachmann’s bundle. For each site (BB and RAA), temporary atrial pacing in the AAI mode was established at 10 beats per minute above the sinus rate and a detailed trans-thoracic echocardiogram with tissue Doppler (TDI) analysis was recorded after at least 10 min of atrial pacing to evaluate AEMD.

Results

Temporary RAA pacing did not show statistically significant differences in inter-AEMD (48.2 ± 17.8 vs 50.5 ± 16.5 ms; P = 0.8), intra-left AEMD (43.3 ± 15.5 vs 44.6 ± 15.8 ms; P = 0.1), or intra-right-AEMD (14.1 ± 4.2 vs 15.4 ± 5.8 ms; P = 0.9), in comparison with sinus rhythm. Temporary BB pacing determined a significantly lower inter-AEMD (36.1 ± 17.1 vs 50.5 ± 16.5 ms; P = 0.001) and intra-left AEMD (32.5 ± 15.2 vs 44.6 ± 15.8 ms; P = 0.001) values in comparison with temporary RAA pacing. No statistically significant difference was found in intra-right AEMD (12.2 ± 4.6 vs 15.4 ± 5.8 ms; P = 0.2). In the control group, neither temporary RAA pacing nor temporary BB pacing showed statistically significant differences in inter-AEMD, intra-left AEMD, or intra-right AEMD values in comparison with sinus rhythm.

Conclusions

In DM1 patients undergoing dual-chamber PM implantation, atrial pacing in the Bachmann bundle region is associated with significantly lower echocardiographic indices of atrial electromechanical delay (inter-AEMD and intra-left AEMD) in comparison with RAA pacing.

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Authors and Affiliations

  1. Chair of Cardiology, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy

    Vincenzo Russo, Anna Rago & Gerardo Nigro

  2. Department of Experimental Medicine, Cardiomyology and Medical Genetics, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Andrea Antonio Papa & Luisa Politano

  3. Naples, Italy

    Andrea Antonio Papa

  4. Department of Cardiology, Umberto I Hospital, Nocera, Salerno, Italy

    Giulia Arena

Authors
  1. Vincenzo Russo
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  2. Anna Rago
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  6. Gerardo Nigro
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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Russo, V., Rago, A., Papa, A.A. et al. Bachmann bundle pacing reduces atrial electromechanical delay in type 1 myotonic dystrophy patients. J Interv Card Electrophysiol 51, 229–236 (2018). https://doi.org/10.1007/s10840-018-0331-5

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  • DOI: https://doi.org/10.1007/s10840-018-0331-5

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