Electrophysiological significance of the interatrial conduction including cavo‐tricuspid isthmus during atrial fibrillation

Key points The interatrial conduction, including Bachmann's bundle, the posterior septal conduction, the anterior septal conduction, and the cavo‐tricuspid isthmus, contributes to the maintenance mechanisms of atrial fibrillation in a 3D biatrial model. The interatrial conduction ablation inclu...

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Published in:The Journal of physiology 2020-09, Vol.598 (17), p.3597-3612
Main Authors: Lim, Byounghyun, Park, Je‐Wook, Hwang, Minki, Ryu, Ah‐Jin, Kim, In Soo, Yu, Hee Tae, Joung, Boyoung, Shim, Eun Bo, Pak, Hui‐Nam
Format: Article
Language:English
Subjects:
Ablation
atrial fibrillation
Atrial Fibrillation - surgery
Atrium
Cardiac arrhythmia
Catheter Ablation
Catheters
cavo‐tricuspid isthmus
computational modelling
Computer applications
Conduction
Fibrillation
Heart Atria - diagnostic imaging
Heart Atria - surgery
Heart Rate
Humans
interatrial conduction
Pulmonary Veins
Septum
Treatment Outcome
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Summary:Key points The interatrial conduction, including Bachmann's bundle, the posterior septal conduction, the anterior septal conduction, and the cavo‐tricuspid isthmus, contributes to the maintenance mechanisms of atrial fibrillation in a 3D biatrial model. The interatrial conduction ablation including a cavo‐tricuspid isthmus ablation significantly affects the wave dynamics of atrial fibrillation (AF) and facilitates the AF termination or atrial tachycardia conversion of the AF after the circumferential pulmonary vein isolation. Additional cavo‐tricuspid isthmus ablation after the circumferential pulmonary vein isolation improves long‐term rhythm outcome after clinical AF catheter ablation. Although it is known that atrial fibrillation (AF) is mainly a left atrial (LA) disease, the role of the right atrium (RA) and interatrial conduction (IAC), including the cavo‐tricuspid isthmus (CTI), has not been clearly defined. We tested AF wave dynamics with or without IAC in computational modelling and the rhythm outcome of AF catheter ablation (AFCA) including CTI ablation in clinical cohort data. We evaluated the dominant frequency (DF) in 3D biatrial AF simulations integrated with 3D‐computed tomograms obtained from 10 patients. The IAC was implemented at Bachmann's bundle, posterior septum and the CTI. After virtual circumferential PV isolation (CPVI), we disconnected IACs one by one, and observed the wave dynamics. We compared the long‐term rhythm outcome after CPVI alone and additional CTI ablation in 846 patients with AFCA. LA‐DF was higher than RA‐DF in AF (P 
ISSN:0022-3751
1469-7793
DOI:10.1113/JP279660