Background. Bachmann’s bundle (BB) is the main pathway of interatrial connection that could be involved in the development of atrial fibrillation (AF). Based on this hypothesis, we raised a novel ablation strategy, BB modification in addition to circumferential pulmonary vein isolation (CPVI-BB) in patients with AF. Methods. A retrospective cohort of patients with AF who underwent CPVI-BB or CPVI alone from March 2018 to July 2021 was enrolled in our study. Propensity score matching was performed in patients with paroxysmal AF and persistent AF, respectively, to reduce the risk of selection bias between the treatment strategies (CPVI-BB or CPVI alone). The primary endpoint was overall freedom from atrial arrhythmia recurrence through 12 months of follow-up. Results. Our propensity score-matched cohort included 82 patients with paroxysmal AF (CPVI group: n = 41; CPVI-BB group: n = 41) and 168 patients with persistent AF (CPVI group: n = 84; CPVI-BB group: n = 84). Among patients with persistent AF, one-year freedom from atrial arrhythmia recurrence rate was 83.3% in the CPVI-BB group and 70.2% in the CPVI group (log-rank  = 0.047). Among patients with paroxysmal AF, no significant difference was found in the primary endpoint between two groups (85.4% in the CPVI-BB group vs. 80.5% in the CPVI group; log-rank  = 0.581). In addition, procedure-related complications and recurrence of atrial tachycardia or atrial flutter were similar between the two treatment groups, regardless of the type of AF. Conclusions. BB modification in addition to CPVI is an effective approach in increasing the maintenance of sinus rhythm in patients with persistent AF, while it does not improve the clinical outcomes of radiofrequency catheter ablation in patients with paroxysmal AF.

中文翻译：

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巴赫曼束改良加环肺静脉隔离治疗心房颤动：一种新颖的消融策略

背景。巴赫曼束（BB）是房间连接的主要通路，可能参与心房颤动（AF）的发展。基于这一假设，我们提出了一种新的消融策略，即对 AF 患者进行 BB 改良加环肺静脉隔离 (CPVI-BB)。方法。我们的研究纳入了 2018 年 3 月至 2021 年 7 月期间接受 CPVI-BB 或单独 CPVI 的 AF 患者回顾性队列。分别对阵发性 AF 和持续性 AF 患者进行倾向评分匹配，以降低治疗策略（CPVI-BB 或单独 CPVI）之间选择偏倚的风险。主要终点是在 12 个月的随访期间总体上没有房性心律失常复发。结果。我们的倾向评分匹配队列包括 82 名阵发性 AF 患者（CPVI 组：n  = 41；CPVI-BB 组：n  = 41）和 168 名持续性 AF 患者（CPVI 组：n  = 84；CPVI-BB 组：n  = 84）。在持续性房颤患者中，CPVI-BB 组一年内无房性心律失常复发率为 83.3%，CPVI 组为 70.2%（对数秩 = 0.047）。在阵发性 AF 患者中，两组之间的主要终点没有显着差异（CPVI-BB 组为 85.4%，CPVI 组为 80.5%；对数秩 = 0.581）。此外，无论房颤类型如何，两个治疗组之间与手术相关的并发症以及房性心动过速或心房扑动的复发相似。结论。CPVI 之外的 BB 改良是增加持续性 AF 患者窦性心律维持的有效方法，但它不能改善阵发性 AF 患者射频导管消融的临床结果。