Optimal site for atrial lead implantation in myotonic dystrophy patients: the role of Bachmann's Bundle stimulation

Aim: The aim of this study was to identify the optimal site for atrial lead implantation in myotonic dystrophy type 1 (MD1) patients. Methods: The atrial pacing lead was positioned in the high-lateral right atrial wall (site A), then in the right atrial appendage (site B), and finally on the interatrial septum (site C) in 22 patients. Pacing and sensing thresholds were obtained for all sites. The lead was repositioned and fixed at the optimal site, defined as the location with the lowest pacing and the highest sensing thresholds. Results: Mean pacing thresholds were 1.46 ± 0.32 V at site A, 1.45 ± 0.33 V at site B, and 0.84 ± 0.24 V at site C. P-wave amplitude was 1.52 ± 0.45 mV at site A, 1.52 ± 0.49 mV at site B, and 2.60 ± 0.48 mV at site C. Atrial lead was implanted at site C in all patients without complications. Conclusions: Interatrial septum in the region of Bachmann’s Bundle seems to be the optimal site for atrial lead implantation in MD1 patients.