John Bullinga, MD and Kurt Schillinger, MD, take opposing views on rotor mapping ablation. Dr. Bullinga, as advocate, argues that the future of atrial fibrillation ablation includes the ablation of rotors (rotational circuits or focal beats). In defending this assertion, he emphasizes recent basic and clinical studies to argue for the existence of rotors in the electrophysiological substrate for AF and for the theoretical efficacy of rotor ablation versus pulmonary vein isolation (PVI) for the elimination for freedom from AF.
In rebuttal, Dr. Schillinger argues that stable electrical rotors do not exist in human AF, that efforts to define their physiological importance in AF are premature and that the efficacy of rotor ablation versus standard pulmonary vein isolation has yet to be demonstrated in randomized, prospective studies.
Both physicians offer counter rebuttals.