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Updated: Feb 9, 2026
High-Resolution Endocardial and Epicardial Optical Mapping in a Sheep Model of Stretch-Induced Atrial Fibrillation
Published on: July 29, 2011
Unraveling the Underlying Arrhythmia Mechanism in Persistent Atrial Fibrillation: Results From the STARLIGHT Study
Nicholas Child1, Richard H Clayton2, Caroline H Roney3
1Department of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom (N.C., C.R.R., T.J., B.P., S.A.N., R.S.R.). nchild@hotmail.com.
Background:
The mechanisms that initiate and sustain persistent atrial fibrillation are not well characterized. Ablation results remain significantly worse than in paroxysmal atrial fibrillation in which the mechanism is better understood and subsequent targeted therapy has been developed. The aim of this study was to characterize and quantify patterns of activation during atrial fibrillation using contact mapping.
Methods:
Patients with persistent atrial fibrillation (n=14; mean age, 61±8 years; ejection fraction, 59±10%) underwent simultaneous biatrial contact mapping with 64 electrode catheters. The atrial electrograms were transformed into phase, and subsequent spatiotemporal mapping was performed to identify phase singularities (PSs).
Results:
PSs were located in both atria, but we observed more PSs in the left atrium compared with the right atrium (779±302, 552±235; P=0.015). Although some PSs of duration sufficient to complete >1 rotation were detected, the maximum PS duration was only 1150 ms, and the vast majority (97%) of PSs persisted for too short a period to complete a full rotation. Although in selected patients there was evidence of PS local clustering, overall, PSs were distributed globally throughout both chambers with no clear anatomic predisposition. In a subset of patients (n=7), analysis was repeated using an alternative established atrial PS mapping technique, which confirmed our initial findings.
Conclusions:
No sustained rotors or localized drivers were detected, and instead, the mechanism of arrhythmia maintenance was consistent with the multiple wavelet hypothesis, with passive activation of short-lived rotational activity.
Clinical Trial Registration:
URL: https://www.clinicaltrials.gov. Unique identifier: NCT01765075.
Insights
Persistent atrial fibrillation mechanisms remain unclear. This study found no sustained rotors, suggesting a multiple wavelet hypothesis with short-lived rotational activity maintains the arrhythmia, unlike paroxysmal atrial fibrillation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Mechanisms driving persistent atrial fibrillation (AF) are poorly understood.
- Ablation success rates for persistent AF lag behind those for paroxysmal AF.
- This study aimed to elucidate AF mechanisms using advanced contact mapping.
Purpose of the Study:
- To characterize and quantify activation patterns during persistent atrial fibrillation.
- To identify the underlying mechanisms responsible for maintaining the arrhythmia.
Main Methods:
- Simultaneous biatrial contact mapping with 64-electrode catheters in 14 patients with persistent AF.
- Analysis of atrial electrograms, phase transformation, and spatiotemporal mapping to detect phase singularities (PSs).
Main Results:
- Phase singularities were more numerous in the left atrium than the right atrium.
- The vast majority of PSs (97%) were too brief to complete a full rotation.
- PSs were globally distributed, lacking clear anatomical localization.
Conclusions:
- No sustained rotors or localized drivers were identified as the primary mechanism.
- Arrhythmia maintenance appears consistent with the multiple wavelet hypothesis.
- Short-lived rotational activity, rather than stable drivers, likely perpetuates persistent AF.
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