Non-invasive location of re-entrant propagation patterns during atrial fibrillation

Functional rotors have been defined as a mechanism responsible for the maintenance of atrial fibrillation (AF). These re-entrant patterns can be identified in the atrial wall by detecting phase singularities (PS) in the epicardial phase maps. In this study, we evaluate the potential role of body surface phase maps to non-invasively locate atrial sites that may harbor rotors. This technology could be of great interest for diagnosis and treatment of AF. In the present study, we make use of mathematical models of atrial activity to evaluate the representation of SP on the torso and inside the passive volume between heart and torso. A filament was defined as a line connecting in time and space the SPs detected on the diferent layers. Filaments from permanent rotors reach the torso and remain stable over time. Filaments arising at the fibrotic area cancel out with each other at increasing distances from the atria until a single filament reaches the surface with a wider meandering than that of a stable rotor. These results show that the electrical propagation pattern in the atria during AF is reflected in the electrocardiogram. Our simulations demonstrated that rotors that remained stable on the epicardium can be detected noninvasively.