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Bachmann-Bündel-Pacing

Bachmann bundle pacing

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Zusammenfassung

In der Schrittmacher- und ICD-Therapie wird die Vorhofelektrode meist im rechten Vorhofohr („right atrial appendage“, RAA) implantiert. Dies ist zwar einfach, birgt jedoch das Risiko negativer hämodynamischer und elektrophysiologischer Effekte. Atriale Erregungsausbreitung, atriale Kontraktion und atrioventrikuläre Überleitung können durch RAA-Stimulation verzögert und desynchronisiert werden. Dies kann zu Vorhofflimmern, einem stimulationsinduzierten langen AV-Block I°, unnötiger rechtsventrikulärer Stimulation und Entwicklung einer Herzinsuffizienz führen. Eine hochseptale Stimulation nahe dem Vorhofdach, auf dem das Bachmann’sche Bündel verläuft, kann die negativen Folgen einer atrialen Stimulation aus dem Vorhofohr vermeiden und die atriale Erregung synchronisieren, wie die Verkürzung von PQ-Zeit und P‑Wellen-Dauer unter Bachmann-Bündel-Stimulation nahelegt. Einige Techniken zur Implantation atrialer Elektroden am Bachmann-Bündel werden hier vorgestellt, die abgesehen von einer Durchleuchtung in linksanterior obliquer Projektion im Vergleich zur RAA-Stimulation keinen zusätzlichen Implantationsaufwand benötigen. Klinische Studien zur hochseptalen und speziell zur Bachmann-Bündel-Stimulation sind rar. Eigene Daten zeigen einen positiven Effekt bei Patienten mit Sick-Sinus-Syndrom und paroxysmalem Vorhofflimmern, die mindestens 50 % der Zeit atrial stimuliert werden. Die Bachmann-Bündel-Stimulation stellt eine interessante und einfache Option zur optimierten Vorhofstimulation dar. Es wäre wünschenswert, wenn diese Technik zur atrialen Elektrodenpositionierung weitere Verbreitung erfahren und zusätzliche Daten über den klinischen Nutzen generiert würden.

Abstract

In pacemaker and ICD therapy, atrial leads are usually implanted in the right atrial appendage (RAA). This is easy but associated with a risk of negative hemodynamic and electrophysiological effects. Atrial depolarization, atrial contraction, and atrioventricular conduction can be delayed and desynchronized by RAA pacing leading to atrial fibrillation, pacing-induced long first-degree AV block, right ventricular pacing and the development of heart failure. High-septal atrial pacing near Bachmann’s bundle that connects the right and left atrium can prevent the negative effects of RAA pacing and synchronize atrial excitation as demonstrated by the shortening of the PQ time and P wave duration during Bachmann bundle pacing. This review presents techniques to implant atrial leads at Bachmann’s bundle. Apart from fluoroscopy in left anterior oblique projection, no additional effort compared to RAA implantation is required. Clinical studies on Bachmann bundle pacing are sparse; our own results suggest beneficial effects in patients with sick sinus syndrome and paroxysmal atrial fibrillation who receive atrial pacing for ≥50% of the time. Bachmann bundle pacing represents an interesting and simple option for atrial pacing. It is desirable to make this technique known to a wider spectrum of implanters and to generate more data on its clinical potential.

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Authors and Affiliations

  1. Klinik für Innere Medizin – Kardiologie, Diabetologie & Nephrologie, Evangelisches Klinikum Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland

    C. W. Israel, T. Burmistrava & C. Berger

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  1. C. W. Israel
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  2. T. Burmistrava
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  3. C. Berger
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Correspondence to C. W. Israel.

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C.W. Israel, T. Burmistrava und C. Berger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Israel, C.W., Burmistrava, T. & Berger, C. Bachmann-Bündel-Pacing. Herz 43, 584–595 (2018). https://doi.org/10.1007/s00059-018-4755-6

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