Conventional right atrial appendage pacing (RAAp) is associated with adverse clinical outcomes mediated in part by electromechanical atrial delays. Bachmann's bundle pacing (BBp) offers more physiologic atrial activation; however, detailed analysis of pacing site on paced P wave parameters is lacking. Intraprocedural electrocardiograms of 21 consecutive patients undergoing atrial lead implantation were retrospectively analyzed and within-patient comparisons of 7 P wave parameters (P wave duration, P wave voltage, P wave area, PR interval, PR segment, PTFV1 and P wave axis) during sinus rhythm, RAAp and BBp performed. The median basal P wave duration was prolonged at 134.5 ms (Q1,Q3: 120.5, 150.5) and similarly prolonged during RAAp at 144.0 ms (127.0, 176.0) but was significantly reduced with BBp at 98.0 ms (93.0, 116.0; = 0.005 and < 0.001, respectively). The median basal P wave voltage in lead II was normal at 0.11 mV (0.08, 0.15) but significantly reduced during RAAp at 0.08 mV (0.04, 0.11) and greatest during BBp at 0.16 mV (0.09, 0.19; < 0.001 and = 0.003, respectively). The median basal PR interval was top normal at 185.0 ms (163.0, 213.0) and similarly prolonged during RAAp at 204.0 ms (166.5, 221.0) but was significantly shortened during BBp at 163.0 ms (142.0, 208.0; = 0.03 and = 0.001, respectively). BBp has favorable effects on the paced P wave parameters including marked shortening in P wave duration, increase in P wave voltage in lead II and increase in PR segment which may offer significant hemodynamic advantages over conventional RAAp.

中文翻译：

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起搏部位对 P 波参数的影响：右心耳和巴赫曼束的患者内比较

传统右心耳起搏（RAAp）与不良临床结果相关，部分是由机电心房延迟介导的。巴赫曼束起搏 (BBp) 提供更多的生理性心房激活；然而，缺乏起搏部位对起搏 P 波参数的详细分析。回顾性分析连续 21 例心房导线植入患者的术中心电图，并比较窦性期间 7 个 P 波参数（P 波持续时间、P 波电压、P 波面积、PR 间期、PR 段、PTFV1 和 P 波轴）节律、RAAp 和 BBp 进行。中位基础 P 波持续时间延长至 134.5 ms（Q1、Q3：120.5、150.5），并且在 RAAp 期间同样延长至 144.0 ms（127.0、176.0），但随着 BBp 显着缩短至 98.0 ms（93.0、116.0；= 0.005 和< 0.001，分别）。导联 II 的中位基础 P 波电压正常为 0.11 mV (0.08, 0.15)，但在 RAAp 期间显着降低，为 0.08 mV (0.04, 0.11)，在 BBp 期间最大，为 0.16 mV (0.09, 0.19；< 0.001 且 = 0.003，分别）。中位基础 PR 间期在 185.0 ms (163.0, 213.0) 处处于最高正常水平，在 RAAp 期间同样延长为 204.0 ms (166.5, 221.0)，但在 BBp 期间显着缩短为 163.0 ms (142.0, 208.0；分别为 = 0.03 和 = 0.001) ）。BBp 对起搏 P 波参数具有有利影响，包括 P 波持续时间显着缩短、II 导联 P 波电压增加和 PR 段增加，这可能比传统 RAAp 提供显着的血流动力学优势。