Temporal Stability of Rotors and Atrial Activation Patterns in Persistent Human€Atrial Fibrillation

Fro Me xD Ad He Na Ca OBJECTIVES This study aimed to determine the spatiotemporal stability of rotors and other atrial activation patterns over 10 min in longstanding, persistent AF, along with the relationship of rotors to short cycle-length (CL) activity. BACKGROUND The prevalence, stability, and mechanistic importance of rotors in human atrial fibrillation (AF) remain unclear. METHODS Epicardial mapping was performed in 10 patients undergoing cardiac surgery, with bipolar electrograms recorded over 10 min using a triangular plaque (area: 6.75 cm; 117 bipoles; spacing: 2.5 mm) applied to the left atrial posterior wall (n 1⁄4 9) and the right atrial free wall (n 1⁄4 4). Activations were identified throughout 6 discrete 10-s segments of AF spanning 10 min, and dynamic activation mapping was performed. The distributions of 4,557 generated activation patterns within each mapped region were compared between the 6 segments. RESULTS The dominant activation pattern was the simultaneous presence of multiple narrow wave fronts (26%). Twelve percent of activations represented transient rotors, seen in 85% of mapped regions with a median duration of 3 rotations. A total of 87% were centered on an area of short CL activity (<100 ms), although such activity had a positive predictive value for rotors of only 0.12. The distribution of activation patterns and wave-front directionality were highly stable over time, with a single dominant pattern within a 10-s AF segment recurring across all 6 segments in 62% of mapped regions. CONCLUSIONS In patients with longstanding, persistent AF, activation patterns are spatiotemporally stable over 10 min. Transient rotors can be demonstrated in the majority of mapped regions, are spatiotemporally associated with short CL activity, and, when recurrent, demonstrate anatomical determinism. (J Am Coll Cardiol EP 2015;1-2:14–24) © 2015 by the American College of Cardiology Foundation. m the *Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; yDepartment of Medicine, University of lbourne, Melbourne, Australia; zDepartment of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia; epartment of Surgery, University of Melbourne, Melbourne, Australia; kCentre for Heart Rhythm Disorders, University of elaide and Royal Adelaide Hospital, Adelaide, Australia; and the {Department of Cardiology, Alfred Hospital and Baker IDI art and Diabetes Institute, Melbourne, Australia. Dr. Walters has received a Postgraduate Research Scholarship from the tional Health and Medical Research Council and the National Heart Foundation of Australia. Dr. Lee has received an Early reer Fellowship from the National Health and Medical Research Council of Australia. Dr. Morris has received a British Heart J A C C : C L I N I C A L E L E C T R O P H Y S I O L O G Y V O L . 1 , N O . 1 2 , 2 0 1 5 Walters et al. M A R C H / A P R I L 2 0 1 5 : 1 4 – 2 4 Transient Rotors in Human Persistent AF 15 AB BR E V I A T I O N S