Successful ablation of biatrial tachycardia with preserved electrical activation of left atrial appendage by unidirectional connection via Bachmann’s bundle: A case report
A 57-year-old man underwent his seventh ablation session for atrial tachycardia (AT). His previous ablations involved several regions of the right atrium (RA) and left atrium (LA). The AT was characterized as biatrial tachycardia with a circuit involving the mitral annulus and septal RA. The AT was...
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doaj-b932fc5113c64a25bb08b174eea6d47b2020-11-25T02:18:23ZengElsevierIndian Pacing and Electrophysiology Journal0972-62922020-07-01204166169Successful ablation of biatrial tachycardia with preserved electrical activation of left atrial appendage by unidirectional connection via Bachmann’s bundle: A case reportHironori Ishiguchi0Masaaki Yoshida1Masahiro Ishikura2Tetsuya Kawabata3Tsuyoshi Oda4Corresponding author. Division of Cardiology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan.; Division of Cardiology, Shimane Prefectural Central Hospital, Izumo, JapanDivision of Cardiology, Shimane Prefectural Central Hospital, Izumo, JapanDivision of Cardiology, Shimane Prefectural Central Hospital, Izumo, JapanDivision of Cardiology, Shimane Prefectural Central Hospital, Izumo, JapanDivision of Cardiology, Shimane Prefectural Central Hospital, Izumo, JapanA 57-year-old man underwent his seventh ablation session for atrial tachycardia (AT). His previous ablations involved several regions of the right atrium (RA) and left atrium (LA). The AT was characterized as biatrial tachycardia with a circuit involving the mitral annulus and septal RA. The AT was terminated by ablation through the insertion site of Bachmann’s bundle (BB) in both atria. After 3 months, the patient underwent his eighth ablation session because of AT recurrence. Activation maps showed that the connection from the RA to LA and vice versa was maintained via BB and the coronary sinus, respectively. The ablation target to interrupt the AT circuit was the mitral isthmus (MI), not BB, because BB supplied the electrical activation of the left atrial appendage (LAA) via a unidirectional electrical connection from the RA to LA. Ablation attempts from within the coronary sinus were performed to target the epicardial connection in the MI and led to complete blockage of the connection from the LA to RA. Otherwise, the connection from the RA to LA was preserved via BB. The patient was free of symptoms and anti-arrhythmic drugs at the 4-month follow-up. However, he had a high risk of electrical isolation of the LAA because extensive ablations had been performed; the strategy of targeting the MI contributed to the balance between preserving the electrical activation of the LAA and treating the biatrial tachycardia. Verification of the connective pathway between the two atria might be helpful to determine the optimal target.http://www.sciencedirect.com/science/article/pii/S0972629220300437Biatrial tachycardiaBachmann’s bundleElectrical isolation of left atrial appendageMitral isthmus |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hironori Ishiguchi Masaaki Yoshida Masahiro Ishikura Tetsuya Kawabata Tsuyoshi Oda |
spellingShingle |
Hironori Ishiguchi Masaaki Yoshida Masahiro Ishikura Tetsuya Kawabata Tsuyoshi Oda Successful ablation of biatrial tachycardia with preserved electrical activation of left atrial appendage by unidirectional connection via Bachmann’s bundle: A case report Indian Pacing and Electrophysiology Journal Biatrial tachycardia Bachmann’s bundle Electrical isolation of left atrial appendage Mitral isthmus |
author_facet |
Hironori Ishiguchi Masaaki Yoshida Masahiro Ishikura Tetsuya Kawabata Tsuyoshi Oda |
author_sort |
Hironori Ishiguchi |
title |
Successful ablation of biatrial tachycardia with preserved electrical activation of left atrial appendage by unidirectional connection via Bachmann’s bundle: A case report |
title_short |
Successful ablation of biatrial tachycardia with preserved electrical activation of left atrial appendage by unidirectional connection via Bachmann’s bundle: A case report |
title_full |
Successful ablation of biatrial tachycardia with preserved electrical activation of left atrial appendage by unidirectional connection via Bachmann’s bundle: A case report |
title_fullStr |
Successful ablation of biatrial tachycardia with preserved electrical activation of left atrial appendage by unidirectional connection via Bachmann’s bundle: A case report |
title_full_unstemmed |
Successful ablation of biatrial tachycardia with preserved electrical activation of left atrial appendage by unidirectional connection via Bachmann’s bundle: A case report |
title_sort |
successful ablation of biatrial tachycardia with preserved electrical activation of left atrial appendage by unidirectional connection via bachmann’s bundle: a case report |
publisher |
Elsevier |
series |
Indian Pacing and Electrophysiology Journal |
issn |
0972-6292 |
publishDate |
2020-07-01 |
description |
A 57-year-old man underwent his seventh ablation session for atrial tachycardia (AT). His previous ablations involved several regions of the right atrium (RA) and left atrium (LA). The AT was characterized as biatrial tachycardia with a circuit involving the mitral annulus and septal RA. The AT was terminated by ablation through the insertion site of Bachmann’s bundle (BB) in both atria. After 3 months, the patient underwent his eighth ablation session because of AT recurrence. Activation maps showed that the connection from the RA to LA and vice versa was maintained via BB and the coronary sinus, respectively. The ablation target to interrupt the AT circuit was the mitral isthmus (MI), not BB, because BB supplied the electrical activation of the left atrial appendage (LAA) via a unidirectional electrical connection from the RA to LA. Ablation attempts from within the coronary sinus were performed to target the epicardial connection in the MI and led to complete blockage of the connection from the LA to RA. Otherwise, the connection from the RA to LA was preserved via BB. The patient was free of symptoms and anti-arrhythmic drugs at the 4-month follow-up. However, he had a high risk of electrical isolation of the LAA because extensive ablations had been performed; the strategy of targeting the MI contributed to the balance between preserving the electrical activation of the LAA and treating the biatrial tachycardia. Verification of the connective pathway between the two atria might be helpful to determine the optimal target. |
topic |
Biatrial tachycardia Bachmann’s bundle Electrical isolation of left atrial appendage Mitral isthmus |
url |
http://www.sciencedirect.com/science/article/pii/S0972629220300437 |
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