Reconceptualising Atrial Fibrillation Using Renewal Theory: A Novel Approach to the Assessment of Atrial Fibrillation Dynamics

Jing Xian Quah; Dhani Dharmaprani; Anandaroop Lahiri; Kathryn Tiver; Anand N Ganesan

doi:10.15420/aer.2020.42

Reconceptualising Atrial Fibrillation Using Renewal Theory: A Novel Approach to the Assessment of Atrial Fibrillation Dynamics

Arrhythm Electrophysiol Rev. 2021 Jul;10(2):77-84. doi: 10.15420/aer.2020.42.

Authors

Jing Xian Quah^{1

2}, Dhani Dharmaprani^{1

3}, Anandaroop Lahiri², Kathryn Tiver^{1

2}, Anand N Ganesan^{1

2}

Affiliations

¹ College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA, Australia.
² Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia.
³ College of Science and Engineering, Flinders University of South Australia, Adelaide, SA, Australia.

Abstract

Despite a century of research, the mechanisms of AF remain unresolved. A universal motif within AF research has been unstable re-entry, but this remains poorly characterised, with competing key conceptual paradigms of multiple wavelets and more driving rotors. Understanding the mechanisms of AF is clinically relevant, especially with regard to treatment and ablation of the more persistent forms of AF. Here, the authors outline the surprising but reproducible finding that unstable re-entrant circuits are born and destroyed at quasi-stationary rates, a finding based on a branch of mathematics known as renewal theory. Renewal theory may be a way to potentially unify the multiple wavelet and rotor theories. The renewal rate constants are potentially attractive because they are temporally stable parameters of a defined probability distribution (the exponential distribution) and can be estimated with precision and accuracy due to the principles of renewal theory. In this perspective review, this new representational architecture for AF is explained and placed into context, and the clinical and mechanistic implications are discussed.

Keywords: AF; mechanistic; renewal theory.

Publication types

Review