Targeting Bachmann’s bundle in hybrid ablation for long standing persistent atrial fibrillation: a proof of concept study

Abstract

Introduction. Catheter-based or surgical procedures in patients with long-standing persistent atrial fibrillation (LSPAF) remain a challenge. As a result, different approaches including hybrid (surgical and endocardial) ablation have been developed. Bachmann's bundle (BB) is a mainly epicardial structure capable of sustaining arrhythmic reentry that could be involved in the development and perpetuation of atrial fibrillation. We investigated the efficacy and safety of an adjunctive BB ablation in LSPAF patients undergoing hybrid ablation. Methods. In a two arm non randomized study, consecutive LSPAF patients undergoing epicardial isolation of pulmonary veins with left atrial posterior wall (box-lesion) with (n=30, BB-group) and without additional BB ablation (n=30, CONV-group) were enrolled in the study. All patients underwent an endocardial procedure within 6 weeks post-surgery to assess for potential lesion gaps and additional atrial substrate modification. The primary endpoint was freedom from AF through 12 months of follow-up. Results. The two-staged hybrid ablation was successfully completed in all patients. One-year freedom from atrial arrhythmias recurrence rates was 96.6% in the BB group vs 76.6% in the CONV group (p=0.025). At procedure completion, 30 (100%) and 17 (56%) patients had a spontaneous cardioversion in BB and CONV group respectively (p < 0.001). No significant differences in quality of life or complication rates were observed. Conclusions. This initial experience shows, for the first time, that adjunctive BB ablation in the setting of hybrid ablation for LSPAF is a feasible and effective approach in increasing maintenance of sinus rhythm without increasing complication rates.Targeting Bachmann's bundle in hybrid ablation for long standing persistent atrial fibrillation: a proof of concept study Bachmann's bundle ablation in persistent atrial fibrillation

Left Atrial Appendage Exclusion in Atrial Fibrillation Radiofrequency Ablation during Mitral Valve Surgery: A Single-Center Experience

“…Such results may influence the selection of patients who are eligible for AFSA and may suggest an early timing indication for surgery (ML-LAD ≤ 6 cm), with associated concomitant LAA exclusion. It will be of primary importance to focus further attention on different aspects in the literature: (1) extensive literature review and prospective studies to identify the main predictors of the efficacy of atrial fibrillation ablation; (2) possible alternative sites that may improve the outcome of this technique, such as ablation of Bachmann's bundle [ 42 ]; (3) a comparison of the energies and strategies used.…”