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Updated: Sep 29, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Radiofrequency catheter ablation of an atriofascicular pathway during atrial fibrillation: a case report
J M Miller1, G R Harper, S A Rothman
1Department of Medicine, Temple University Hospital, Philadelphia, PA 19140.
Insights
Catheter ablation successfully treated an atriofascicular pathway during atrial fibrillation. This approach allowed for precise mapping and ablation, resolving both the initial arrhythmia and a subsequent atrioventricular nodal reentry tachycardia.
Area of Science:
- Electrophysiology
- Cardiac Arrhythmia Management
- Interventional Cardiology
Background:
- A male patient presented with symptomatic preexcited atrial fibrillation.
- An atriofascicular pathway was identified as the arrhythmogenic substrate.
Observation:
- Catheter ablation of the atriofascicular pathway was performed exclusively during spontaneous atrial fibrillation.
- Mapping focused on the pathway's insertion into the right bundle branch.
Findings:
- Successful ablation of the atriofascicular pathway was achieved.
- A subsequent atrioventricular nodal reentry tachycardia was identified and eliminated via slow pathway modification.
- No recurrence of atrial fibrillation or atrioventricular nodal reentry was observed during follow-up.
Implications:
- This case demonstrates the feasibility of mapping and ablating atriofascicular pathways during atrial fibrillation.
- Mapping the ventricular insertion site is crucial for successful ablation.
- The study highlights potential interactions between accessory pathways and other reentrant circuits.
Introduction:
A male patient with an atriofascicular pathway underwent catheter ablation of the atriofascicular pathway during atrial fibrillation.
Methods And Results:
The patient had preexcited atrial fibrillation both clinically and repeatedly during electrophysiologic study. A preexcited tachycardia with a 1:1 AV relationship and regular RR intervals was also induced. Catheter ablation of the atriofascicular pathway could only be performed during persistent atrial fibrillation, based on mapping of the pathway's insertion into the right bundle branch. Following successful ablation and cardioversion to sinus rhythm, a regular QRS tachycardia (atrioventricular [AV] nodal reentry) having the same rate, atrial activation sequence, and His-atrial time as the regular preexcited tachycardia noted preablation was initiated. An AV nodal slow pathway modification eliminated this tachycardia. Neither atrial fibrillation nor AV nodal reentry has recurred on follow-up.
Conclusion:
This is the first report of atriofascicular mapping and ablation performed exclusively during atrial fibrillation and illustrates the utility of mapping the pathway's ventricular insertion. Other unusual features ("bystander" pathway activation during AV nodal reentry, possible role of the pathway in genesis of atrial fibrillation) are discussed.
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