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AF Inducibility Is Related to Conduction Abnormalities at Bachmann's Bundle.

ABSTRACT: We investigated whether patterns of activation at Bachmann's bundle are related to AF inducibility. Epicardial mapping of Bachmann's bundle during sinus rhythm was performed prior to cardiac surgery (192 electrodes, interelectrode distances: 2 mm). Compared to non-inducible patients (N = 20), patients with inducible AF (N = 34) had longer lines of conduction block (18(2-164) mm vs. 6(2-28) mm, p = 0.048), prolonged total activation time (55(28-143) ms vs. 46(24-73) ms, p = 0.012), multiple wavefronts entering Bachmann's bundle more frequently (64% vs. 37%, p = 0.046) and more often areas of simultaneous activation (conduction velocity > 1.7 m/s, 45% vs. 16%, p = 0.038). These observations further support a relation between conduction abnormalities at Bachmann's bundle and AF inducibility. The next step is to examine whether Bachmann's bundle activation patterns can also be used to identify patients who will develop AF after cardiac surgery during both short- and long-term follow-up.

SUBMITTER: van Staveren LN

PROVIDER: S-EPMC8658171 | biostudies-literature | 2021 Nov

REPOSITORIES: biostudies-literature

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AF Inducibility Is Related to Conduction Abnormalities at Bachmann's Bundle.

van Staveren Lianne N LN van der Does Willemijn F B WFB Heida Annejet A Taverne Yannick J H J YJHJ Bogers Ad J J C AJJC de Groot Natasja M S NMS

Journal of clinical medicine 20211126 23

We investigated whether patterns of activation at Bachmann's bundle are related to AF inducibility. Epicardial mapping of Bachmann's bundle during sinus rhythm was performed prior to cardiac surgery (192 electrodes, interelectrode distances: 2 mm). Compared to non-inducible patients (N = 20), patients with inducible AF (N = 34) had longer lines of conduction block (18(2-164) mm vs. 6(2-28) mm, p = 0.048), prolonged total activation time (55(28-143) ms vs. 46(24-73) ms, p< ...[more]

PMID: 34884237

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Project description:BackgroundThe right ventricular outflow tract (RVOT) is acknowledged to be responsible for arrhythmogenesis in Brugada syndrome (BrS), but the pathophysiology remains controversial.ObjectivesThis study assessed the substrate underlying BrS at post-mortem and in vivo, and the role for open thoracotomy ablation.MethodsSix whole hearts from male post-mortem cases of unexplained sudden death (mean age 23.2 years) with negative specialist cardiac autopsy and familial BrS were used and matched to 6 homograft control hearts by sex and age (within 3 years) by random risk set sampling. Cardiac autopsy sections from cases and control hearts were stained with picrosirius red for collagen. The RVOT was evaluated in detail, including immunofluorescent stain for connexin-43 (Cx43). Collagen and Cx43 were quantified digitally and compared. An in vivo study was undertaken on 6 consecutive BrS patients (mean age 39.8 years, all men) during epicardial RVOT ablation for arrhythmia via thoracotomy. Abnormal late and fractionated potentials indicative of slowed conduction were identified, and biopsies were taken before ablation.ResultsCollagen was increased in BrS autopsy cases compared with control hearts (odds ratio [OR]: 1.42; p = 0.026). Fibrosis was greatest in the RVOT (OR: 1.98; p = 0.003) and the epicardium (OR: 2.00; p = 0.001). The Cx43 signal was reduced in BrS RVOT (OR: 0.59; p = 0.001). Autopsy and in vivo RVOT samples identified epicardial and interstitial fibrosis. This was collocated with abnormal potentials in vivo that, when ablated, abolished the type 1 Brugada electrocardiogram without ventricular arrhythmia over 24.6 ± 9.7 months.ConclusionsBrS is associated with epicardial surface and interstitial fibrosis and reduced gap junction expression in the RVOT. This collocates to abnormal potentials, and their ablation abolishes the BrS phenotype and life-threatening arrhythmias. BrS is also associated with increased collagen throughout the heart. Abnormal myocardial structure and conduction are therefore responsible for BrS.

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AF Inducibility Is Related to Conduction Abnormalities at Bachmann's Bundle.

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AF Inducibility Is Related to Conduction Abnormalities at Bachmann's Bundle.

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