STRUCTURED 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.
Key words: atrial fibrillation ablation; long-standing
persistent atrial fibrillation; hybrid ablation; Bachmann’s bundle;
posterior wall isolation.