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Updated: Jan 10, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Atrial and Ventricular Dyssynchrony, Cardiomyopathy, and Atrial Fibrillation: To Synchronize or to Ablate First?
Qiying Dai1, Samuel Asirvatham2, Yong-Mei Cha2
1Department of Cardiovascular Diseases, Mayo Clinic Health System, La Crosse, Wisconsin, USA.
Insights
This study shows that Bachmann bundle/left bundle branch area pacing combined with AV node ablation can restore heart function and eliminate atrial fibrillation in patients with cardiomyopathy and left bundle branch block.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Persistent atrial fibrillation, cardiomyopathy, and dyssynchrony with left bundle branch block present complex management challenges.
- Current optimal treatment strategies for these patients remain unclear.
Background:
Optimal management in patients presenting with persistent atrial fibrillation, cardiomyopathy, and atrial as well as ventricular dyssynchrony with left bundle branch block is unclear.
Results And Methods:
A 67-year-old female patient presented with persistent atrial fibrillation, cardiomyopathy with a newly reduced ejection fraction (EF), increased P wave duration on electrocardiogram (ECG) and left bundle branch block. After shared decision making, the patient elected to proceed with Bachman bundle/left bundle branch area pacing plus atrioventricular (AV) node ablation. At 6-month follow-up post procedure, a repeat echocardiogram showed normalized atrial size and EF (65%). Device interrogation demonstrated no recurrent atrial fibrillation with the patient off antiarrhythmic and heart failure medical therapy.
Conclusions:
Integrated atrial and ventricular synchronization through Bachmann bundle and left bundle branch area pacing may help break the cycle of dyssynchrony, remodeling, and arrhythmia. In combination with AV node ablation, it may be considered as an alternative treatment option in certain cases after shared decision making.
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