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

 Byounghyun Lim  ;  Je-Wook Park  ;  Minki Hwang  ;  Ah-Jin Ryu  ;  In Soo Kim  ;  Hee Tae Yu  ;  Boyoung Joung  ;  Eun Bo Shim  ;  Hui-Nam Pak 
 JOURNAL OF PHYSIOLOGY-LONDON, Vol.598(17) : 3597-3612, 2020-09 
Journal Title
Issue Date
atrial fibrillation ; cavo-tricuspid isthmus ; computational modelling ; interatrial conduction
Abstract: 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 < 0.001). After CPVI, the DF decreased significantly by additional IAC ablation (P = 0.003), especially in the LA (P = 0.016). The amount of DF reduction (P = 0.020) and rates of AF termination (P < 0.001) or AT conversion (P = 0.021) were significantly higher after IAC ablations including CTI than those without. In clinical AFCA, the AF recurrence rate was significantly lower in patients with additional CTI ablation than CPVI alone during 25 ± 20 months' follow-up (hazard ratio 0.60 [0.46-0.79], P < 0.001, Log rank P < 0.001). IAC contributes to the maintenance mechanism of AF, and IAC including CTI ablation affects AF wave dynamics, facilitating AF termination in 3D biatrial modelling. Additional CTI ablation after CPVI improves the long-term rhythm outcome in clinical AFCA, potentially in a paroxysmal type with accompanying atrial flutter, or atrial dimension close to normal.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, In-Soo(김인수) ORCID logo https://orcid.org/0000-0003-2801-5514
Park, Je Wook(박제욱)
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
Lim, Byounghyun(임병현)
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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