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Prospective cross-sectional study using Poisson renewal theory to study rotor formation and destruction rates in atrial fibrillation

Dr Jing Xian Quah, Institution: Flinders University

2020 Health Professional Scholarship

Years funded: 2021-2023


Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with stroke, heart failure and death. AF is a progressive condition; it starts with short-lasting episodes, that may progress to a more sustained form. A fundamental knowledge gap is that there is no objective metric to measure the progression of AF. The ability to measure the progression from paroxysmal to persistent forms could enable tailored early targeted intervention (e.g. catheter ablations) in patients who are rapidly progressing but allow a more conservative approach in patients with stable AF.


A characteristic feature of AF is the presence of unstable re-entrant electrical circuits known as rotors. Our team in Flinders has recently shown that using a statistical approach; Poissons renewal theory, rotors in AF patients form (λ f) and destroy (λ d) at a measurable constant rate, specific for each AF patient. This novel concept has been peer-reviewed and published in Circ AE, a leading electrophysiology journal. This study (RENEWAL-AF) aims to build on this finding, by developing λ f and λ d as non-invasive prognostic markers of AF progression.

RENEWAL-AF is a multi-centre study with ethics approved HREC/19/SAC/292, is funded by NHF Vanguard Grant 102650 with recruitment commenced March 2020, and target recruitment of n=100 patients. Part 1 of this study involves measuring λ f and λ d in patients with different AF characteristics and burden levels, who are undergoing AF ablation. We aim to relate λ f and λ d to currently known clinical, imaging and electrophysiologic markers of AF progression, and burden measured by loop recorder. In Part 2, a machine learning approach will be used to non-invasively assess λ f and λ d from surface ECG. This will allow measurement of the physiological progression of AF objectively, allowing optimally timed interventional and medical therapies. Ultimately, this could avoid unnecessary invasive operations in patients with physiologically stable AF.

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