Rotor, Rotor Everywhere…. Nor any Place to Find….

Dhanunjaya Lakkireddy MD, FACC, FHRS, Andrea Natale MD, FACC, FECS, FHRS

Dear colleagues

Great to see many of you at the 36th Annual Heart Rhythm Society Annual sessions in Boston past week. It became quite obvious that the next frontier that is ahead of us is clearly the success bar for persistent atrial fibrillation therapy. What particularly bemused us was the amount of interest in the concept of rotors. Attempts to find rotors using non-contact mapping, contact mapping and body surface mapping are quite interesting and exciting. And then there is the counter argument that questions the very existence of rotors. Big companies, start-up companies and companies yet to form …. Everyone wants to solve this puzzle of rotors. A large percentage of abstracts related to persistent AF had their fair share of rotors. It is perhaps important to remind ourselves of the saga of the sailor from the “The Rime of the Ancient Mariner”. For the years ahead of us the search for this elusive, invisible, untamable perpetrators of AF shall continue.

In this edition of JAFIB, we have some comprehensive review articles related to the management of AF in chronic kidney disease, epicardial approaches to outflow tract ventricular tachycardias, impact of age and gender on AF ablation complications, improving cardiac resynchronization delivery tools. Few interesting case reports on the use of cryo balloon ablation in complex pulmonary vein anatomies and left atrial tachycardia are worth reading. Van Stipdonk and colleagues presented a thorough on utilizing EKG patterns in CRT for better understanding of optimization. It opens up a lot of insights into the conduction abnormalities in patient with cardiomyopathy and the process of cardiac resynchronization.

A cost effectiveness comparison of Dabigatran versus warfarin by Galvani etal is an important read. Stabile and colleagues described the impact of contact force ablation tools on fluoroscopy reduction adding important information that highlights the value of the new generation of ablation catheters. A detailed review of Amplatzer Cardiac Plug and its successor Amulet by Kapadia and group discusses the current data on this left atrial appendage exclusion device.

Our heart goes out to the victims of the earthquakes in Nepal. Please send your contributions to the Red Cross at and Habitat for Humanity at where medical help and reconstruction of homes is the top priority.

Have a wonderful summer


Dhanunjaya (DJ)Lakkireddy MD, FACC, FHRS Associate Editor JAFIB

Andrea Natale MD, FACC, FHRS, FESC Editor-in-Chief JAFIB