Quantifying separability of ablation outcome regions from rotor trajectory kinematics using residence threshold labelling in persistent atrial fibrillation

Shamsu Idris Abdullahi, Ahmad Daoud Ahmad Ramahi, Abdulhamed Mohammed Jasim, Noor Qaqos, Ekenedirichukwu Nelson Obianom, Fan Feng, G. Andre Ng, Xin Li
University of Leicester


Abstract

Rotor-guided ablation assumes rotor behaviour marks effective targets in atrial fibrillation, but whether basic trajectory descriptors separate positive from negative regions stays unclear. We tested rotor duration, mean velocity, and endpoint displacement for a consistent outcome signature in persistent atrial fibrillation. Ten patients undergoing first-time left atrial ablation were analysed using non-contact mapping. Phase singularities from virtual electrograms were linked into rotor trajectories. Regions were labelled positive or negative by clinical response, and a trajectory received that label when 70% or more of its visited nodes fell within one region type. Of 3118 candidate trajectories, 283 qualified: 140 positive, 143 negative. Kinematic values overlapped heavily between groups and varied widely between patients. Paired comparisons found no significant differences in any descriptor. A logistic model built from all three failed to generalise, with accuracy near or below chance. Rotor kinematics remain patient-specific and descriptive, not a reliable standalone marker for ablation targeting.