Prospective cross-sectional study using Poisson renewal theory to study phase singularity formation and destruction rates in atrial fibrillation (RENEWAL-AF): Study design

Background: Unstable functional reentrant circuits known as rotors have been consistently observed in atrial fibrillation and are mechanistically believed critical to the maintenance of the arrhythmia. Recently, using a Poisson renewal theory-based quantitative framework, we have demonstrated that rotor formation (λ_f) and destruction rates (λ_d) can be measured using in vivo electrophysiologic data. However, the association of λ_f and λ_d with clinical, electrical, and structural markers of atrial fibrillation phenotype is unknown. Methods: RENEWAL-AF is a multicenter prospective cross-sectional study recruiting adult patients with paroxysmal or persistent atrial fibrillation undergoing clinically indicated catheter ablation. Patients will undergo intraprocedural electrophysiologic atrial fibrillation mapping, with λ_f and λ_d to be determined from 2-minute unipolar electrogram recordings acquired before ablation. The primary objective will be to determine the association of λ_f and λ_das markers of fibrillatory dynamics with clinical, electrical, and structural markers of atrial fibrillation clinical phenotype, measured by preablation transthoracic echocardiogram and cardiac magnetic resonance imaging. An exploratory objective is the noninvasive assessment of λ_f and λ_d using surface ECG characteristics via a machine learning approach. Results: Not applicable. Conclusion: This pilot study will provide insight into the correlation between λ_f/λ_d with clinical, electrophysiological, and structural markers of atrial fibrillation phenotype and provide a foundation for the development of noninvasive assessment of λ_f/λ_d using surface ECG characteristics will help expand the use of λ_f/λ_d in clinical practice.