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

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.