AFib rotors: Are we in the 'driver' seat?

摘要

Great strides in catheter-based ablation of paroxysmal atrial fibrillation (AF) have been made with pulmonary vein isolation serving as the cornerstone of the ablative approach. However, the optimal ablation strategy for persistent and long-term persistent AF remains unknown (1,2). Long-term maintenance of sinus rhythm still presents challenges because the precise mechanisms perpetuating AF are not fully understood. In this issue of the iJACC, Ravelli et al. (3) investigate the anatomic distribution of possible rotor sources in patients with AF by fusion of biatrial computed tomography (CT) images with bipolar catheter recordings. The underlying assumptions are that AF-sustaining rotors can be mapped in the human atria and display 2 basic characteristics: atrial depolarization is very rapid and very stable. The investigators quantify and display these 2 attributes by measuring atrial cycle length (CL) and wave similarity (WS), respectively. The CL analysis provides a local measure of the fibrillatory rate, determining among organized sources those with the shortest CL. The algorithm for WS analysis was previously developed by the investigators (4,5) and is a technique to assess directional organization during fibrillation.