Understanding Atrial Fibrillation Complexity Through the Lens of Turbulence Dynamics: Implications for Treatment Strategies

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice. Its incidence increases significantly with age and has become a major global public health issue. Although research into the mechanisms of AF has spanned over a century-ranging from the reentry theory to the rotor hypothesis-none of these theories can fully explain its complex dynamic characteristics. The electrical activity of AF exhibits similarities to fluid turbulence, and this analogy provides a new theoretical framework for understanding AF. This review systematically outlines the evolution of AF theories and analyzes the multidimensional connections between the electrophysiological properties of atrial myocardium and the principles of turbulence dynamics. These include the nonlinear propagation characteristics of electrical wavefronts, the impact of atrial tissue heterogeneity on wave conduction, and the therapeutic rationale of catheter ablation targeting the sources of turbulence. Based on this, the study proposes the hypothesis that cardiac electrical activity in AF resembles a turbulence-like state, suggesting that AF fundamentally represents a nonlinear dynamic turbulence-like phenomenon of myocardial excitation waves under certain conditions. This hypothesis posits that critical arrhythmogenic substrates in AF-characterized by established structural and electrophysiological heterogeneities-create conditions analogous to sites where turbulence dynamics emerge in fluid systems, providing a phenomenological framework for characterizing the spatial-temporal organization underlying ablation therapy efficacy. By integrating traditional AF theories with fluid dynamics concepts of turbulence, this hypothesis holds promise for more comprehensively explaining the complex characteristics and individual variability of AF, thereby offering a new theoretical foundation for improving AF management outcomes.