Ablation of Bachmann's bundle tachycardias post-persistent AF ablation terminated arrhythmias in 68% and resulted in 70% arrhythmia-free survival over 2.3 years.
Does catheter ablation of Bachmann's bundle-related atrial tachycardias prevent recurrent arrhythmias in patients with persistent atrial fibrillation?
Bachmann's bundle can be a critical source of focal or reentrant atrial tachycardias after persistent AF ablation, and targeted ablation yields a 70% long-term freedom from recurrence.
Absolute Event Rate: 0% vs 0%
Abstract Background Bachmann’s bundle (BB) is an epicardial structure that provides interatrial conduction and may be a critical structure for post atrial fibrillation (AF) ablation arrhythmias. BB-related atrial tachycardias (AT) have not been well characterized. Purpose To describe the electrophysiologic, anatomic, and follow-up characteristics of patients undergoing ablation of BB-related AT. Methods The region of BB was defined as the anterior left atrium immediately outside the antrum of the right superior pulmonary vein, cranial to the fossa ovalis. A BB-dependent AT was defined as an AT that originated from this region (focal, based on activation mapping), or was shown to be involved in a reentrant circuit (by entrainment and activation mapping), or if it acutely terminated to sinus rhythm during radiofrequency (RF) ablation. Results Thirty-one patients with persistent AF (age 69±9 years, men n=24, BMI 33±6 kg/m2, left atrial size 47±6 mm, ejection fraction 54±12%) were included. Twenty-seven (87%) had a mean of 1.7±1.2 procedures, previously. Four patients had BB ATs during a first-time ablation which developed after ablation initially targeting AF. The presenting rhythm was sinus in 7, AF in 7, and AT in 18 patients. The mechanism of BB ATs was focal in 7 (23%) or macro-reentry in 24 (77%), which included perimitral reentrant participation in 15 (48%). An abrupt rise in real-time impedance and/or contact force was noted in 9 patients (29%) as the catheter was withdrawn into the BB region, compatible with a pouch. A pouch at BB insertion site was seen in 6/16 patients (38%) who had pre-procedural cross-sectional imaging. Ablation at BB resulted in arrhythmia termination in 21 patients (68%), slowing without termination in 8 patients (26%), or no effect in 2 patients (6%). Tachycardia termination required RF ablation from the corresponding site in the right atrium in 9 (29%) patients. Repeat ablation for AT was performed in 8 patients, the clinical arrhythmia involved BB in 5/8 patients (63%). There were no complications. After 2.3±1.4 years of follow up, 20/31 patients (70%) were free from recurrent arrhythmias. Conclusion The region of BB bundle can be the source of a focal or reentrant tachycardias after a prior ablation for persistent AF. An anatomic pouch may be seen at the critical site, which requires meticulous mapping and ablation to prevent complications. Strategies such as epicardial ablation should be explored to improve long-term outcomes.Figure 1
Christian-Miller et al. (Sat,) reported a other. Ablation of Bachmann's bundle tachycardias post-persistent AF ablation terminated arrhythmias in 68% and resulted in 70% arrhythmia-free survival over 2.3 years.