Bachmann's Bundle Versus Right Atrial Appendage Pacing

Inclusion Criteria: * Patients undergoing a de novo cardiac implantable electronic device (CIED) (i.e. pacemaker, implantable cardioverter-defibrillator (ICD), CRT) implant with an atrial lead * Medtronic CIED system used * Age 18 years or older * Able to read and understand English AND EITHER 1)willing and capable of providing informed consent OR 2) in case of incompetence, be represented by a legally authorized representative (LAR), relative/associate with power of attorney (POA), or other recognized surrogate decision-maker who can read and understand English and is willing and capable of providing consent. * Able and willing to participate in all examinations and follow-up visits and tests associated with this clinical study Exclusion Criteria: * Prior CIED implant * Known pericarditis or pericardial effusion * New York Heart Association (NYHA) Functional Class IV * Severe valvular disease expected to require surgical intervention within 12 months. * History of abnormal bleeding and/or clotting disorder * Severe lung disease, pulmonary hypertension, or any lung disease requiring home supplemental oxygen. * Organ or hematologic transplant, or currently being evaluated for an organ transplant * Women who are pregnant or breastfeeding. This will be assessed clinically as per pre-procedure clinical workflow, and the research coordinator will capture the data.