Prevalence, characteristics, mapping, and catheter ablation of potential rotors in nonparoxysmal atrial fibrillation

Yenn Jiang Lin, Men Tzung Lo, Chen Lin, Shih Lin Chang, Li Wei Lo, Yu Feng Hu, Wan Hsin Hsieh, Hung Yu Chang, Wen Yu Lin, Fa Po Chung, Jo Nan Liao, Yun Yu Chen, Dicky Hanafy, Norden E. Huang, Shih Ann Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

65 Scopus citations


Background: Identification of critical atrial substrates in patients with nonparoxysmal atrial fibrillation (AF) failing to respond to pulmonary vein isolation is important. This study investigated the signal characteristics, substrate nature, and ablation results of rotors during AF. Methods and Results: In total, 53 patients (age=55±8), 31 with persistent AF and 22 with long-lasting AF, underwent pulmonary vein isolation and substrate modification of complex fractionated atrial electrograms. Small-radius-reentrant rotors were identified from signal analyses of the dominant frequency and fractionation interval and nonlinear analyses (newly developed, beat-to-beat nonlinear measurement of the repetitiveness of the electrogram morphology >6 seconds). In 15% of the patients, activation maps demonstrated occurrences of rotor-like small-radius reentrant circuits (n=9;1.1 per patient; cycle length=110±21 ms; diameter=11±6 mm) with fibrillation occurring outside these areas. Rotors were identified by conventional point-by-point mapping and signal analyses and were subsequently eradicated by catheter ablation in these patients. Persistent AF for <1 year, a smaller left atrial size, substrates with higher mean voltages and shorter total activation durations predicted a higher incidence of rotors (all P<0.05). In the multivariable model, areas of reentrant circuits exhibited a higher dominant frequency, kurtosis, and higher degree of a beat-to-beat electrogram similarity than areas without or outside the rotors (all P<0.05). Conclusions: Rotor-like re-entry with fibrillatory conduction was found in a limited number of patients with nonparoxysmal AF after pulmonary vein isolation. Those areas were characterized by rapid repetitive activity with a high degree of electrogram similarity.

Original languageEnglish
Pages (from-to)851-858
Number of pages8
JournalCirculation: Arrhythmia and Electrophysiology
Issue number5
StatePublished - Oct 2013


  • Atrial fibrillation
  • Atrium
  • Catheter ablation
  • Electrocardiography
  • Mapping


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