Correction of advanced interatrial block with Bachmann’s bundle pacing

Advanced interatrial block (AIAB), defined as P wave duration > 120 ms and biphasic P wave morphology in the inferior leads, is associated with increased risk for stroke, heart failure, development of atrial fibrillation, and death.1 AIAB serves as a risk marker, with therapies focused on treating associated conditions rather than the conduction abnormality itself. Bachmann’s bundle is the primary route for impulse conduction from the right to the left atrium, and interruption of this muscle bundle leads to interatrial conduction delay with the electrocardiographic pattern of AIAB.