Role of Endomyocardial Biopsy and Bachmann's Bundle Pacing for Sinus Node Dysfunction in Cardiac Amyloidosis

BACKGROUND: Light-chain cardiac amyloidosis (AL-CA) is a rare disease caused by amyloid fibril deposition in the myocardium. Evidence on Bachmann's bundle (BB) pacing in patients with AL-CA and sinus node dysfunction (SND) remains scarce. CASE SUMMARY: A 74-year-old woman with SND and worsening heart failure was admitted to our hospital. An endomyocardial biopsy during pacemaker implantation was helpful in the diagnosis of AL-CA. After the pacing study, it was found that high right atrial septal pacing near the BB region produced a higher P-wave amplitude and shorter duration than sinus rhythm and right atrial appendage pacing. The findings indicate that BB pacing not only preserves sinus rhythm, it also enhances overall cardiac efficiency. DISCUSSION: Few reports of BB pacing for SND exist in the literature. This case demonstrates a safe and effective method of improving heart failure outcomes. TAKE-HOME MESSAGE: BB pacing may be a safe and effective treatment for patients with AL-CA and SND.