Abstract 18427: Rotors and Focal Sources for Human Atrial Fibrillation Are Spatially and Temporally Stable
Introduction: Several groups now report electrical rotors or focal sources sustaining human atrial fibrillation (AF) after it has been triggered. However, some groups report stable sources while others report transient rotational activity.
Hypothesis: We hypothesized that AF rotors would be spatially stable in a large multi center experience, using phase mapping.
Methods: We prospectively mapped AF in 277 patients (181 persistent, 61±12 years) at 6 centers in the FIRM-registry, using basket catheters with 64 contact electrodes per atrium. AF was mapped by RhythmView (Topera Inc) before ablation. FIRM uses phase analysis and dynamic physiological analysis of repolarization and conduction. AF propagation movies were interpreted by each operator to assess the stability and dynamics of AF sources in multiple maps over tens of minutes prior to ablation.
Results: Sources were identified in 258 of 260 of patients in whom AF was mapped (99%), for 2.8±1.4 sources/patient. Patients showed 1.8±1.1 left atrial and 1.1±0.8 right atrial sources. On FIRM mapping, each source was stable for 4196±6360 cycles, with no difference between patients with paroxysmal vs persistent AF (4290±5847 vs 4150±6604, p=0.78), or right vs left atrial sources (p=0.26) (Figure). Rotors showed precession ('wobble') in ~2 cm2 areas, and spiral arms disorganized (‘fibrillatory conduction)’ beyond a spatial domain that varied around each rotor core for each patient, and between patients.
Conclusions: Rotors and focal sources for human AF are stable for thousands of cycles during mapping using FIRM. These data show that AF rotors are distinct from macro-reentry. Notably, rotors precess within small atrial regions, and emanating spiral arms disorganize variably into the fibrillatory milieu in agreement with basic science studies. These results provide a rationale for FIRM-guided ablation at AF sources, and explain why rotors have been difficult to detect using traditional mapping approaches.
Author Disclosures: V. Swarup: Research Grant; Modest; Medtronic, Boston Scientific, St Jude Medical, Biotronik. Consultant/Advisory Board; Modest; Biosense Webster. T. Baykaner: None. J. Zaman: None. J. Daubert: Research Grant; Significant; Boston Scientific, Biosense Webster, Medtronic, Gilead Sciences. Ownership Interest; Significant; Biosense Webster. Consultant/Advisory Board; Modest; Medtronic, St Jude Medical, Boston Scientific, Sorin Group, CardioFocus. Other; Significant; Medtronic, Boston Scientific, Biotronik, St Jude Medical, Biosense Webster, Bard Electrophysiology. J. Hummel: Research Grant; Modest; Biosense Webster. Consultant/Advisory Board; Modest; Medtronic. D.E. Krummen: Other; Significant; Boston Scientific, Medtronic, St Jude Medical, Biotronik. J. Miller: Consultant/Advisory Board; Modest; Boston Scientific, Medtronic, Biotronik, Biosense Webster, Stereotaxis, Topera. G. Tomassoni: Speakers Bureau; Modest; St Jude Medical, Biosense Webster, Medtronic, Boston Scientific, Siemens, Pfizer, Sterotaxis, Topera. Consultant/Advisory Board; Modest; St Jude Medical, Biosense Webster, Medtronic, Boston Scientific, Siemens, Stereotaxis, Topera. S. Narayan: Honoraria; Modest; Medtronic, Biotronik, Janssen. Research Grant; Significant; NIH. Ownership Interest; Significant; Topera, Inc.. Consultant/Advisory Board; Significant; Topera, Inc.
- © 2014 by American Heart Association, Inc.