Key result
Catheter ablation targeting the specialized conduction system, including Bachmann's bundle, successfully restored and maintained normal sinus rhythm at one year in a patient with persistent atrial fibrillation.
Why the study?
Catheter ablation remains challenging in persistent and long-standing persistent AF, requiring isolation of additional triggers or perpetuating substrates beyond the pulmonary veins, such as the Bachmann and septopulmonary bundles.
Case Report (n=1)
No
Targeting the specialized conduction system, including the Bachmann's bundle, may be an effective substrate modification strategy for managing long-standing persistent atrial fibrillation.
Hypothesis-generating for conduction system targeting in persistent AF; should not yet change practice.
Catheter ablation has become the mainstream treatment of atrial fibrillation, but still remains a challenge in those patient with persistent and long standing persistent atrial fibrillation. In addition of isolation of the pulmonary veins, any other areas that can trigger or perpetuate atrial fibrillation need to be isolated. Current technologies may allow to effectively deliver permanently lasting lesions, and therefore improve clinical outcomes after ablation. The specialized conduction system including the Bachmann and septopulmonary bundles, are important substrate targets for the management of atrial fibrillation. The anatomical location of these fibers, and the corresponding approach for ablation are described in this case.
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Mitchell et al. (2020) conducted a case report in Persistent atrial fibrillation (n=1). Catheter ablation targeting inter- and intra-atrial bundles (Bachmann's bundle) was evaluated on Maintenance of normal sinus rhythm. Catheter ablation targeting the specialized conduction system, including Bachmann's bundle, successfully restored and maintained normal sinus rhythm at one year in a patient with persistent atrial fibrillation.
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