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Targeting Bachmann’s bundle in hybrid ablation for long standing persistent atrial fibrillation: a proof of concept study
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  • Giuseppe De Martino,
  • Giuseppe Nasso,
  • Alessio Gasperetti,
  • Marco Moscarelli,
  • Carmine Mancusi,
  • Giuseppe Della Ratta,
  • Claudia Calvanese,
  • Gianfranco MitacchioneOrcid,
  • Raffaele Bonifazi,
  • Nicola Di Bari,
  • Enrico Vassallo,
  • Marco Schiavone,
  • Marco Gaudino,
  • Giovanni Battista ForleoOrcid,
  • Giuseppe Speziale
Giuseppe De Martino
Anthea Hospital
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Giuseppe Nasso
Anthea Hospital
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Alessio Gasperetti
IRCCS Centro Cardiologico Monzino
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Marco Moscarelli
Anthea Hospital
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Carmine Mancusi
Clinica Mediterranea
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Giuseppe Della Ratta
Clinica Mediterranea
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Claudia Calvanese
Clinica Mediterranea
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Gianfranco Mitacchione
Orcid
Luigi Sacco University Hospital
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Raffaele Bonifazi
Anthea Hospital
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Nicola Di Bari
Clinica Mediterranea
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Enrico Vassallo
Clinica Mediterranea
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Marco Schiavone
Luigi Sacco University Hospital
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Marco Gaudino
Weill Cornell Medical College
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Giovanni Battista Forleo
Orcid
Ospedale Luigi Sacco-Polo Universitario
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Giuseppe Speziale
Anthea Hospital
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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.