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Updated: Nov 16, 2025

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New Insights Into Understanding Rotor Versus Focal Activation in Patients With Persistent Atrial Fibrillation.

Seungyup Lee1, Celeen M Khrestian1, Jayakumar Sahadevan2

  • 1Departments of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.

JACC. Clinical Electrophysiology
|February 28, 2021
PubMed
Summary

Repetitive re-entry near a focal source can create stable rotors in the atria during atrial fibrillation (AF). This study found no true re-entry, suggesting incomplete re-entry mechanisms are key in persistent AF.

Keywords:
atrial fibrillationfocal sourcesmappingreentryrotors

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Area of Science:

  • Electrophysiology
  • Cardiac Arrhythmias
  • Computational Biology

Background:

  • Phase analysis in persistent atrial fibrillation (AF) yields different mechanistic insights than traditional activation sequence analysis.
  • Focal sources in persistent AF can generate repetitive, incomplete re-entry (Wannabe re-entry).

Purpose of the Study:

  • To test if repetitive Wannabe re-entry generates phase singularity points (rotors) using phase analysis.
  • To determine if stable rotor locations are proximal to focal sources.

Main Methods:

  • Simultaneous multi-electrode (510-512) atrial activation recording during open-heart surgery in 12 persistent AF patients.
  • Performed activation sequence mapping and phase analyses on 4-second data segments.
  • Examined activation patterns of stable rotors (>2 full rotations at the same site).

Main Results:

  • Phase singularity points (rotors) were detected in all patients during AF.
  • Stable rotors were found in 6 of 12 patients (0-6 per patient, 14 total).
  • Stable rotors originated from repetitive Wannabe re-entry near focal sources or passive activation; conduction block also created rotors in 2 cases. The average distance between focal source and stable rotor was 0.9 ± 0.3 cm.

Conclusions:

  • Repetitive Wannabe re-entry generates stable rotors adjacent to focal sources.
  • No instances of true re-entry were observed, indicating incomplete re-entry mechanisms are significant in persistent AF.