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Ripple mapping: Initial multicenter experience of an intuitive approach to overcoming the limitations of 3D activation mapping
Author(s) -
Luther Vishal,
CortezDias Nuno,
Carpinteiro Luís,
Sousa João,
Balasubramaniam Richard,
Agarwal Sharad,
Farwell David,
Sopher Mark,
Babu Girish,
Till Richard,
Jones Nikki,
Tan Stuart,
Chow Anthony,
Lowe Martin,
Lane Jem,
Pappachan Naveen,
Linton Nicholas,
Kanagaratnam Prapa
Publication year - 2017
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13308
Subject(s) - medicine , ablation , atrial tachycardia , tachycardia , catheter ablation , reproducibility , ventricular tachycardia , nuclear medicine , radiofrequency ablation , confidence interval , algorithm , radiology , cardiology , statistics , computer science , mathematics
Background Ripple mapping (RM) displays electrograms as moving bars over a three‐dimensional surface displaying bipolar voltage, and has shown in a single‐center series to be effective for atrial tachycardia (AT) mapping without annotation of local activation time or window‐of‐interest assignment. We tested the reproducibility of these findings in operators naïve to RM, using it for the first time in postablation AT. Methods Maps were collected with multielectrode catheters and CARTO ConfiDENSE. A diagnosis of the tachycardia mechanism was made using RM and an assessment of operator confidence was made according to a three‐grade scale (1 highest—3 lowest). Results The first 20 patients (64 ± 9 years, median two previous ablations) undergoing RM‐guided AT ablation across five sites were studied. High‐density maps (2,935 ± 1,328 points) in AT (CL = 296 ± 95 milliseconds) were collected. Macroreentrant ATs bordered by scar or anatomical obstacles were identified in n = 12 (60%), small reentrant ATs around scar in n = 3 (15%), and focal ATs from scar in n = 5 (25%). Diagnostic confidence with RM was grade 1 in n = 13 (65%), where operators felt confident to proceed to ablation without entrainment. Ablation offered the correct diagnosis n = 18 (90%). Retrospective review of the accompanying LAT maps demonstrated potential sources for error related to the window of interest selection, interpolation, and differentiating regions of scar during tachycardia on the voltage map. Conclusion RM was easy to adopt by operators using it for the first time, and identified the correct target for ablation with high diagnostic confidence in most cases of complex AT.