AI-Enabled ECG Mapping to Guide Leadless Atrial Pacemaker Implantation in the Bachmann's Bundle Region.

BACKGROUND: Physiologic atrial pacing at the Bachmann's bundle region may improve biatrial synchrony, but accurate implantation of atrial leadless pacemakers remains challenging. FIH/EARLY REPORT SUMMARY: We report the first case of artificial intelligence (AI)-enabled electrocardiogram (ECG) mapping-guided implantation of an atrial leadless pacemaker in the Bachmann's bundle region. An 86-year-old woman with symptomatic tachy-brady syndrome and bilateral subclavian venous occlusion underwent implantation of an atrial leadless pacemaker guided by intracardiac echocardiography and AI-enabled ECG mapping. Mapping demonstrated earliest activation in the anterior-superior left atrium, consistent with Bachmann's-bundle-region pacing. Implantation was successful without procedural complications. DISCUSSION: This case demonstrates the feasibility of AI-enabled mapping to facilitate physiologic atrial leadless pacing. NOVELTY: First reported use of AI-enabled ECG mapping to guide Bachmann's-bundle-region atrial leadless pacemaker implantation. TAKE-HOME MESSAGE: AI-enabled ECG mapping may enable precise targeting of the Bachmann's bundle region to achieve individualized physiologic atrial pacing.