Prevalence, Characteristics, Mapping, and Catheter Ablation of Potential Rotors in Non-Paroxysmal Atrial Fibrillation

CIRCEP:  August 27, 2013

Background—Identification of critical atrial substrates in nonparoxysmal atrial fibrillation (AF) patients failing to respond to pulmonary vein isolation (PVI) is important. This study investigated the signal characteristics, substrate nature, and ablation results of rotors during AF.

Methods and Results—In total 53 patients (age=55±8), 31 with persistent AF and 22 with long-lasting AF, underwent PVI and substrate modification of complex fractionated atrial electrograms (CFAEs). Small-radius-reentrant rotors were identified from signal analyses of the dominant frequency (DF), fractionation interval (FI) and nonlinear analyses (newly developed, beat-to-beat nonlinear measurement of the repetitiveness of the electrogram morphology over 6 seconds). In 15% of the patients, activation maps demonstrated occurrences of rotor-like small-radius reentrant circuits (N=9, 1.1 per patient, cycle length=110±21 ms; diameter=11±6 mm) with fibrillation occurring outside these areas. Rotors were identified by conventional point-by-point mapping and signal analyses, and were subsequently eradicated by catheter ablation in these patients. Read more