Why the study?
Nontransmural lesions causing ablation gaps in depth commonly cause recurrent mitral annular atrial flutter, and epicardial mapping near the Bachmann bundle may clarify difficulties in achieving durable anterior block.
Epicardial mapping can reveal epicardial bridging over endocardial block as a mechanism for recurrent mitral annular atrial flutter, highlighting the 3-D complexity of ablation lesions.
Endocardial block may not suffice to prevent recurrent MAFL; leaves open the role of epicardial mapping in refractory cases.
The left atrium is typically perceived as a thin-walled chamber without anatomic impediments to creating transmural ablation lesions. However, nontransmural lesions are a common cause of recurrent mitral annular atrial flutter (MAFL),1 representing ablation gaps in 3-D (depth). Percutaneous epicardial mapping in the region of the Bachmann bundle (BB) may provide mechanistic evidence for the difficulties associated with creating durable anterior block for MAFL. We report a case of MAFL with epicardial bridging over a previously blocked endocardial anterior linear lesion set.
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Yu et al. (2020) studied this question.
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