{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T19:26:55Z","timestamp":1790364415223,"version":"4.1.0"},"reference-count":52,"publisher":"Wiley","issue":"17","license":[{"start":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T00:00:00Z","timestamp":1592956800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003625","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["HI18C0070"],"award-info":[{"award-number":["HI18C0070"]}],"id":[{"id":"10.13039\/501100003625","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003625","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["HI19C0114"],"award-info":[{"award-number":["HI19C0114"]}],"id":[{"id":"10.13039\/501100003625","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["NRF\u20102020R1A2B01001695"],"award-info":[{"award-number":["NRF\u20102020R1A2B01001695"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["NRF\u20102019R1C1C1009075"],"award-info":[{"award-number":["NRF\u20102019R1C1C1009075"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["NRF\u20102017R1A2B4003983"],"award-info":[{"award-number":["NRF\u20102017R1A2B4003983"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Physiology"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec><jats:title>Key points<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>The interatrial conduction, including Bachmann's bundle, the posterior septal conduction, the anterior septal conduction, and the cavo\u2010tricuspid isthmus, contributes to the maintenance mechanisms of atrial fibrillation in a 3D biatrial model.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>The interatrial conduction ablation including a cavo\u2010tricuspid 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.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Additional cavo\u2010tricuspid isthmus ablation after the circumferential pulmonary vein isolation improves long\u2010term rhythm outcome after clinical AF catheter ablation.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p>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\u2010tricuspid 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\u2010computed 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\u2010term rhythm outcome after CPVI alone and additional CTI ablation in 846 patients with AFCA. LA\u2010DF was higher than RA\u2010DF in AF (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). After CPVI, the DF decreased significantly by additional IAC ablation (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.003), especially in the LA (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.016). The amount of DF reduction (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.020) and rates of AF termination (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) or AT conversion (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.021) 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\u00a0\u00b1\u00a020\u00a0months\u2019 follow\u2010up (hazard ratio 0.60 [0.46\u20130.79], <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001, Log rank <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). 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\u2010term rhythm outcome in clinical AFCA, potentially in a paroxysmal type with accompanying atrial flutter, or atrial dimension close to normal.<\/jats:p><\/jats:sec>","DOI":"10.1113\/jp279660","type":"journal-article","created":{"date-parts":[[2020,6,4]],"date-time":"2020-06-04T09:52:18Z","timestamp":1591264338000},"page":"3597-3612","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Electrophysiological significance of the interatrial conduction including cavo\u2010tricuspid isthmus during atrial fibrillation"],"prefix":"10.1113","volume":"598","author":[{"given":"Byounghyun","family":"Lim","sequence":"first","affiliation":[{"name":"Yonsei University Health System  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Je\u2010Wook","family":"Park","sequence":"additional","affiliation":[{"name":"Yonsei University Health System  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minki","family":"Hwang","sequence":"additional","affiliation":[{"name":"Silicon Sapiens  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ah\u2010Jin","family":"Ryu","sequence":"additional","affiliation":[{"name":"Silicon Sapiens  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In Soo","family":"Kim","sequence":"additional","affiliation":[{"name":"Yonsei University Health System  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee Tae","family":"Yu","sequence":"additional","affiliation":[{"name":"Yonsei University Health System  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9036-7225","authenticated-orcid":false,"given":"Boyoung","family":"Joung","sequence":"additional","affiliation":[{"name":"Yonsei University Health System  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Bo","family":"Shim","sequence":"additional","affiliation":[{"name":"Silicon Sapiens  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3256-3620","authenticated-orcid":false,"given":"Hui\u2010Nam","family":"Pak","sequence":"additional","affiliation":[{"name":"Yonsei University Health System  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,24]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pbiomolbio.2011.06.011"},{"key":"e_1_2_6_3_1","first-page":"2819","article-title":"Electrophysiological substrate for a dominant reentrant source during atrial fibrillation","volume":"2009","author":"Aslanidi OV","year":"2009","journal-title":"Conf Proc IEEE Eng Med Biol Soc"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2008.10.024"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euw219"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccl.2014.07.001"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.12.016"},{"key":"e_1_2_6_8_1","first-page":"1031","article-title":"Atrial fibrillation ablation: importance of cavotricuspid isthmus block","volume":"28","author":"Candeias R","year":"2009","journal-title":"Rev Port Cardiol"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1006\/dbio.2000.9753"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pbiomolbio.2010.05.008"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.18.2370"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.15420\/aer.2016:27:2"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivy236"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.116.004398"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv233"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2007.01028.x"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0172931"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.013985"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2009.05.064"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euu226"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2018.04.017"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euu346"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-013-1090-1"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2012.2201948"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/pace.13799"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0190398"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/0045-7949(80)90149-2"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.103.21.2631"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.01.025"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.107.161182"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00006.2003"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.711622"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1098\/rsta.2011.0139"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2007.07.056"},{"key":"e_1_2_6_35_1","volume-title":"Discrete\u2010Time Signal Processing","author":"Oppenheim AV","year":"1989"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2014.03.009"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.116.004133"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0092-8674(00)81475-0"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2008.153965"},{"key":"e_1_2_6_40_1","first-page":"H643","article-title":"Regional differences in rabbit atrial repolarization: importance of transient outward current","volume":"266","author":"Qi A","year":"1994","journal-title":"Am J Physiol"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euw365"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2005.40659.x"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1098\/rsta.2006.1781"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0182174"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-015-0070-9"},{"key":"e_1_2_6_46_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.113.000758"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.08.066"},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0912585107"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2010.05.040"},{"key":"e_1_2_6_50_1","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvw073"},{"key":"e_1_2_6_51_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.111.967950"},{"key":"e_1_2_6_52_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.005922"},{"key":"e_1_2_6_53_1","doi-asserted-by":"publisher","DOI":"10.1109\/TBME.2003.809505"}],"updated-by":[{"DOI":"10.1113\/jp284816","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T00:00:00Z","timestamp":1681430400000}}],"container-title":["The Journal of Physiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1113%2FJP279660","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1113\/JP279660","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1113\/JP279660","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/physoc.onlinelibrary.wiley.com\/doi\/pdf\/10.1113\/JP279660","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T09:20:34Z","timestamp":1693819234000},"score":1,"resource":{"primary":{"URL":"https:\/\/physoc.onlinelibrary.wiley.com\/doi\/10.1113\/JP279660"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,24]]},"references-count":52,"journal-issue":{"issue":"17","published-print":{"date-parts":[[2020,9]]}},"alternative-id":["10.1113\/JP279660"],"URL":"https:\/\/doi.org\/10.1113\/jp279660","archive":["Portico"],"relation":{"correction":[{"id-type":"doi","id":"10.1113\/JP284816","asserted-by":"object"}]},"ISSN":["0022-3751","1469-7793"],"issn-type":[{"value":"0022-3751","type":"print"},{"value":"1469-7793","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,24]]},"assertion":[{"value":"2020-02-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-05-29","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-06-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}