Rotor hypothesis in the time chain of atrial fibrillation

A trial fibrillation (AF) is the most prevalent arrhythmia in the aging population, with people over 75 years accounting for 70% of the AF population. Over the past twenty years, despite tremendous progress has been made in catheter ablation for rhythm control of AF, we still cannot establish a reliable ablative target for nonparoxysmal AF. Part of the reason is an incomplete understanding of the mechanism underlying the progressive nature of AF. In the time chain of AF, AF burden increases, and the success rate of catheter ablation decreases as AF progresses from paroxysmal AF (PAF) to persistent AF (PerAF) and long-standing persistent AF (LS-PerAF) form. Recently, with the advance in mapping technologies combined with biophysical insight, a new concept of AF maintenance has been introduced--the rotor (spiral waves). Meanwhile, the concept of complete electrical left atrial (LA) isolation has been introduced for AF with extensive atrial fibrosis. These innovative ideas enriched our armamentarium to combat different AF subtypes. This article proposes a rotor hypothesis to illustrate the mechanism underlying AF progress and discuss the application of new strategies in different AF subtypes.