The Bachmann Bundle and Interatrial Conduction

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The cardiac conduction system (CCS) is responsible for generation and systematic conduction of cardiac impulses. The Bachmann Bundle (BB), considered one of its several accessory impulse-conducting pathways, plays a fundamental role in interatrial conduction. Delay in this pathway leads to prolongation of the P wave on the electrocardiogram (interatrial delay or block), which in turn is a precursor for atrial tachyarrhythmias, mainly atrial fibrillation and significant left atrial electromechanical dysfunction. As such, the magnitude of its sequelae has necessitated a flurry of investigations that have been targeted toward its prevention and management. Although current studies on the use of angiotensin-converting enzyme inhibitors and atrial pacing have indeed shown some promise, it would be shortsighted to overlook and circumvent the actual underlying lesion—BB abnormality. Thus, a thorough understanding of the CCS and interatrial conduction is essential. We review current literature on the BB and discuss potential mechanisms that affect its conduction.

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