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

Autor: Eun Bo Shim, Byounghyun Lim, Hui Nam Pak, In Soo Kim, Boyoung Joung, Je Wook Park, Minki Hwang, Ah Jin Ryu, Hee Tae Yu
Rok vydání: 2020
Předmět:
Zdroj: J Physiol
ISSN: 1469-7793
0022-3751
DOI: 10.1113/jp279660
Popis: 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. 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
Databáze: OpenAIRE
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