title: Targeting Stable Rotors to Treat Atrial Fibrillation.
abstract: Therapy for atrial fibrillation (AF) remains suboptimal, in large part because its mechanisms are unclear. While pulmonary vein ectopy may trigger AF, it remains uncertain how AF, once triggered, is actually sustained. Recent discoveries show that human AF is maintained by a small number of rotors or focal sources. AF sources are widely distributed in patient-specific locations, often remote from pulmonary veins and in the right atrium and stable for prolonged periods of time. In a multicentre experience, brief targeted ablation at sources (focal impulse and rotor modulation [FIRM]) terminated AF predominantly to sinus rhythm prior to pulmonary vein isolation and eliminated AF on rigorous followup. This review summarises the evidence for stable rotors and focal sources of human AF and their clinical role as ablation targets to eliminate paroxysmal, persistent and long-standing persistent AF.
authors.affiliation: Professor of Medicine.
authors.forename: Sanjiv M
authors.initials: SM
authors.lastname: Narayan
authors.affiliation: Associate Professor of Medicine, University of California and Veterans' Affairs Medical Centers, San Diego, California.
authors.forename: David E
authors.initials: DE
authors.lastname: Krummen
keywords: Atrial fibrillation; ablation; focal source; human; multiwavelet re-entry; rotor; spiral wave; therapy
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