Bachmann's Bundle versus right atrial appendage capture

The tissue in the high intraatrial septum in the region of Bachmann's Bundle (BB) exhibits electrophysiological properties that differ from the right atrial appendage (BAA). As BB pacing emerges as an alternative to RAA pacing, the feasibility of using automatic capture recognition technology in this location should be examined. At implant, active-fixation leads were consecutively placed in the RAA, then the BB in 18 patients (55.5% men, mean age 77.1 ± 9.1). There was no significant difference between BB and BAA in the average capture threshold (1.12 vs 1.77 V, P = 0.09), sensing threshold (3.85 vs 3.69 mV, P = 0.84), impedance (508 vs 529 Ohms, P = 0.64), evoked response (1.78 vs 1.67 mV, P = 0.83), and polarization (0.41 vs 0.46 mV, P = 0.84) between. The difference in tissue characteristics was not associated with a different evoked response measured by the ventricular capture recognition algorithm. Based on the analogous evoked response and polarization values, capture recognition technology designed for the atrium will most likely be applicable at both pacing sites.