Bachmann’s bundle (BB) can be a critical source of atrial tachycardias after ablation for persistent atrial fibrillation (AF). Data presented at the European Society of Cardiology (ESC) 2025 describe the electrophysiologic, anatomic, and follow-up characteristics of patients undergoing ablation of BB-related tachycardias.

Thirty-one adults with persistent AF (mean age 69 years; 24 men; mean left atrial size 47 mm; mean ejection fraction 54%) were included. Mechanisms of BB-related tachycardias were focal in 23% and macro-reentry in 77%, with perimitral participation in 48%. Pre-procedural imaging identified an anatomic pouch at the BB insertion site in 38% of patients. Radiofrequency ablation at BB achieved arrhythmia termination in 68%, slowed the tachycardia in 26%, and had no effect in 6%. Termination required ablation from the right atrium in 29% of cases. Over 2.3 years of follow-up, 70% remained free from recurrent arrhythmias, with no procedural complications reported.

These findings suggest meticulous mapping and ablation of the BB region, including consideration of anatomical pouches, are essential for successful arrhythmia management. Epicardial ablation strategies may further improve long-term outcomes.