title: Role of Rotors in the Ablative Therapy of Persistent Atrial Fibrillation.
abstract: Atrial fibrillation (AF) ablation is increasingly used to maintain sinus rhythm yet its results are sub-optimal, especially in patients with persistent AF or prior unsuccessful procedures. Attempts at improvement have often targeted substrates that sustain AF after it is triggered, yet those mechanisms are debated. Many studies now challenge the concept that AF is driven by self-sustaining disordered wavelets, showing instead that localised drivers (rotors) may drive disorder via a process known as fibrillatory conduction. Novel mapping using wide-area recordings, physiological filtering and phase analysis demonstrates rotors in human AF. Contact mapping with focal impulse and rotor modulation (FIRM) shows that localised ablation at sources can improve procedural success in many populations on long-term follow up and some newer approaches to rotor mapping are qualitatively similar. This review critically evaluates the data on rotor mapping and ablation, which advances our conceptual understanding of AF and holds the promise of substantially improving ablative outcomes in patients with persistent AF.
authors.affiliation: Department of Cardiovascular Medicine, University of California San Diego Medical Center, San Diego, US.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Schricker
authors.affiliation: Department of Cardiovascular Medicine, Stanford Medicine, Stanford, California, US.
authors.forename: Junaid
authors.initials: J
authors.lastname: Zaman
keywords: Atrial fibrillation; ablation; focal sources; rotors; substrate; trigger
references.citation: J Cardiovasc Electrophysiol. 2012 Dec;23(12):1277-85
references.pmid: 23130890
references.citation: Circ Arrhythm Electrophysiol. 2014 Oct;7(5):816-24
references.pmid: 25217042
references.citation: J Am Coll Cardiol. 2012 Feb 7;59(6):595-606
references.pmid: 22300695
references.citation: J Cardiovasc Electrophysiol. 2014 Dec;25(12):1284-92
references.pmid: 25263408
references.citation: Pacing Clin Electrophysiol. 2007 Mar;30(3):295-303
references.pmid: 17367348
references.citation: Circ Arrhythm Electrophysiol. 2013 Apr;6(2):334-41
references.pmid: 23512204
references.citation: J Cardiovasc Electrophysiol. 2014 May;25(5):477-8
references.pmid: 24446824
references.citation: N Engl J Med. 2006 Mar 2;354(9):934-41
references.pmid: 16510747
references.citation: J Cardiovasc Electrophysiol. 2007 Jul;18(7):757-64
references.pmid: 17578346
references.citation: Eur Heart J. 2014 Jan;35(2):86-97
references.pmid: 23935092
references.citation: JAMA. 2010 Jan 27;303(4):333-40
references.pmid: 20103757
references.citation: J Am Coll Cardiol. 2013 Apr 23;61(16):1713-23
references.pmid: 23500312
references.citation: J Cardiovasc Electrophysiol. 2011 Jul;22(7):729-38
references.pmid: 21332861
references.citation: Pacing Clin Electrophysiol. 2006 Nov;29(11):1209-18
references.pmid: 17100673
references.citation: Heart Rhythm. 2011 Feb;8(2):244-53
references.pmid: 20955820
references.citation: Curr Cardiol Rep. 2014 Aug;16(8):509
references.pmid: 24950671
references.citation: Circulation. 2014 Aug 12;130(7):525-7
references.pmid: 25028390
references.citation: Circ Arrhythm Electrophysiol. 2013 Oct;6(5):851-8
references.pmid: 23983246
references.citation: J Am Coll Cardiol. 2014 May 6;63(17):1761-8
references.pmid: 24632280
references.citation: Circulation. 2004 Nov 16;110(20):3181-6
references.pmid: 15533867
references.citation: J Cardiovasc Electrophysiol. 2014 Sep;25(9):921-9
references.pmid: 24948520
references.citation: Circ Arrhythm Electrophysiol. 2012 Aug 1;5(4):650-8
references.pmid: 22722660
references.citation: Chaos. 2013 Jun;23(2):023113
references.pmid: 23822478
references.citation: J Am Coll Cardiol. 2006 Aug 1;48(3):485-91
references.pmid: 16875973
references.citation: Heart Rhythm. 2014 Sep;11(9):1584-91
references.pmid: 24846374
references.citation: J Am Coll Cardiol. 2008 Oct 7;52(15):1222-30
references.pmid: 18926325
references.citation: Heart Rhythm. 2014 Nov;11(11):2027-34
references.pmid: 25101485
references.citation: Heart Rhythm. 2010 Sep;7(9):1216-23
references.pmid: 20206323
references.citation: J Am Coll Cardiol. 2014 Dec 16;64(23):2455-67
references.pmid: 25500229
references.citation: J Am Coll Cardiol. 2012 Aug 14;60(7):628-36
references.pmid: 22818076
references.citation: N Engl J Med. 1998 Sep 3;339(10):659-66
references.pmid: 9725923
references.citation: Heart Rhythm. 2009 Jul;6(7):1009-17
references.pmid: 19560089
references.citation: Am Heart J. 1959 Jul;58(1):59-70
references.pmid: 13661062
references.citation: J Cardiovasc Electrophysiol. 2000 Aug;11(8):869-79
references.pmid: 10969749
references.citation: Circulation. 1992 Aug;86(2):375-82
references.pmid: 1638706
references.citation: Eur Heart J. 2014 Jun 7;35(22):1432
references.pmid: 24513792
references.citation: JAMA. 2014 Feb 19;311(7):692-700
references.pmid: 24549549
references.citation: Heart Rhythm. 2008 Jun;5(6):846-54
references.pmid: 18534369
references.citation: J Am Heart Assoc. 2013 Mar 18;2(2):e004549
references.pmid: 23537812
references.citation: N Engl J Med. 2012 Oct 25;367(17):1587-95
references.pmid: 23094720
references.citation: Heart Rhythm. 2012 Apr;9(4):632-696.e21
references.pmid: 22386883
references.citation: J Cardiovasc Electrophysiol. 2011 Oct;22(10):1171-3
references.pmid: 21539640
references.citation: Heart Rhythm. 2013 Dec;10(12):1830-8
references.pmid: 24016695
references.citation: Am J Cardiol. 2002 Jun 15;89(12):1381-7
references.pmid: 12062732
references.citation: Circ Arrhythm Electrophysiol. 2013 Feb;6(1):58-67
references.pmid: 23392583
references.citation: Nature. 1992 Jan 23;355(6358):349-51
references.pmid: 1731248
references.citation: Circulation. 2014 Aug 12;130(7):530-8
references.pmid: 25028391
references.citation: Pacing Clin Electrophysiol. 2003 Jun;26(6):1420-3
references.pmid: 12822761
references.citation: J Cardiovasc Electrophysiol. 2012 May;23(5):447-54
references.pmid: 22537106