Open wavefront ablation terminates rotor-driven atrial fibrillation

Atrial arrhythmias, notably atrial fibrillation (AF), exhibit complex spatiotemporal patterns that remain incompletely characterized. Based on topological constraints requiring counter-rotating reentries in two-dimensional manifolds, we present a framework classifying all atrial wavefronts into two fundamental archetypes: open and closed waves. Open waves are line-like structures bounded by endpoints that tend to self-perpetuate; closed waves are ring-like structures lacking endpoints that tend toward self-termination.

We demonstrate that complex wavefront interactions reduce to five elementary processes: (1) Open wave creation, (2) Open wave annihilation, (3) Closed wave creation, (4) Closed wave annihilation and (5) Open wave collision. Validation within a cohort of 600 patient-specific AF simulations showed that all observed events adhered to these constructed topological rules, suggesting that complexity of fibrillatory conduction within the studied computational framework arises from simple underlying principles. Furthermore, closing all open waves, achieved a 100% success rate when electrical silence was used as the primary criteria for efficacy.

This unified framework reconciles existing electrophysiological theories, including the multiple wavelet hypothesis, the mother rotor hypothesis, meandering rotors, and focal sources, while providing a foundation for optimizing clinical interventions.