Rotational Drivers in Atrial Fibrillation: Are Multiple Techniques Circling Similar Mechanisms?

Abstract

See Article by Calvo et al There is an urgent need to define the mechanisms that sustain atrial fibrillation (AF), as ablation at anatomic and empirical targets has not improved outcomes over pulmonary vein isolation alone.1–4 Rotational drivers are promising mechanistic targets which are highly topical, yet for which data continue to accumulate. Scientifically, rotational drivers maintain AF using the gold standard of optical mapping,5 across most species including human atria. Clinically, several studies of rotor ablation show promising results,6 although divergent data7 have to be reconciled. Because AF mechanisms may vary with mapping technique, novel mapping studies in this space are welcome. In this issue of Circulation: Arrhythmia and Electrophysiology , Calvo et al8 studied patients with long-standing persistent AF using a novel technique (CartoFinder) and identified sites of rotational activity. These sites fluctuated yet remained spatially stable over time and, when ablated, the impact on local and remote tissue was consistent with elimination of mechanistic drivers. The authors found stable sites of rotational activity (defined as >3 cycles, observed mean 9.2±2.2) in both …