Key result
Catheter ablation strategies targeting rotors and complex fractionated atrial electrograms have yielded mixed clinical results, highlighting that the mechanisms sustaining atrial fibrillation remain incompletely understood.
This review summarizes the evolving understanding of atrial fibrillation mechanisms, emphasizing the transition from the multiple wavelet hypothesis to the identification of rotors and high-frequency sources as promising targets for novel catheter ablation strategies.
Rotor or CFAE ablation should not yet alter practice; leaves open identification of reliable AF ablation targets.
Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice, yet our understanding of the mechanisms that initiate and sustain this arrhythmia remains quite poor. Over the last 50 years, various mechanisms of AF have been proposed, yet none has been consistently observed in both experimental studies and in humans. Recently, there has been increasing interest in understanding how spiral waves or rotors - which are specific, organised forms of functional reentry - sustain human AF and how they might be therapeutic targets for catheter-based ablation. The following review describes the historical understanding of reentry and AF mechanisms from earlier in the 20th century, advances in our understanding of mechanisms that are able to sustain AF with a focus on rotors and complex fractionated atrial electrograms (CFAEs), and how the study of AF mechanisms has resulted in new strategies for treating AF with novel forms of catheter ablation.
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Waks et al. (2014) conducted a review in Atrial fibrillation. Catheter ablation targeting rotors and complex fractionated atrial electrograms (CFAEs) was evaluated. Catheter ablation strategies targeting rotors and complex fractionated atrial electrograms have yielded mixed clinical results, highlighting that the mechanisms sustaining atrial fibrillation remain incompletely understood.
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