AF-Triggered Bundle Branch Re-Entrant Ventricular Tachycardia Prevented by Atrial Fibrillation Ablation

Q4 Medicine

JACC. Case reports Pub Date : 2026-10-21 Epub Date: 2026-08-12 DOI:10.1016/j.jaccas.2026.109802

Satoshi Sakai MD, PhD, Taku Nishida MD, PhD, Akihiro Takitsume MD, Tsunenari Soeda MD, PhD, Hiroyuki Kawata MD, PhD, Shungo Hikoso MD, PhD

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Abstract

Background

Bundle branch re-entrant ventricular tachycardia (BBR-VT) is a macroreentrant tachycardia involving the right and left bundle branches,¹ with the right bundle branch typically targeted for ablation.

Case Summary

A 68-year-old man with prior myocardial infarction presented with recurrent ventricular tachycardia (VT). Electrophysiological study suggested BBR-VT. VT was inducible only by atrial pacing and occurred clinically exclusively during atrial fibrillation (AF). Therefore, AF ablation alone was performed, resulting in complete suppression of VT.

Discussion

Previous reports have described BBR-VT induced by atrial pacing² or AF.³ When BBR-VT is triggered exclusively by AF, AF ablation may be an effective therapeutic strategy.

Take-Home Messages

In patients with BBR-VT that is triggered exclusively by atrial fibrillation or atrial pacing, elimination of the triggering atrial arrhythmia may suppress VT without the need for bundle branch ablation. Even when AF ablation is effective, implantable cardioverter-defibrillator implantation and careful long-term follow-up remain essential because recurrence of atrial tachyarrhythmias may precipitate VT recurrence.

查看原文本刊更多论文

房颤消融预防af触发的束支再入性室性心动过速。

背景：束束分支再入性室性心动过速（BBR-VT）是一种涉及左右束分支的大再入性心动过速，其中右束分支通常靶向消融。病例总结：一名68岁男性，既往心肌梗死，表现为复发性室性心动过速（VT）。电生理检查提示BBR-VT。室性心动过速仅由心房起搏诱发，临床上仅在房颤（AF）时发生。因此，单独房颤消融可完全抑制vt。讨论：先前的报道已经描述了心房起搏2或AF诱导的BBR-VT。3当BBR-VT完全由房颤触发时，AF消融可能是一种有效的治疗策略。关键信息：对于完全由心房颤动或心房起搏触发的BBR-VT患者，消除触发性心房心律失常可能会抑制VT，而无需束支消融。即使房颤消融有效，植入式心律转复除颤器植入和仔细的长期随访仍然是必要的，因为房性心动过速的复发可能导致室速复发。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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