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Int J Cardiol. 2015 Nov 15;199:391-400. doi: 10.1016/j.ijcard.2015.07.017. Epub 2015 Jul 23.

A diagnostic algorithm to optimize data collection and interpretation of Ripple Maps in atrial tachycardias.

Author information

1
Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, United Kingdom.
2
Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1200 Everett Drive, Oklahoma City, USA.
3
Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, United Kingdom. Electronic address: p.kanagaratnam@imperial.ac.uk.

Abstract

BACKGROUND:

Ripple Mapping (RM) is designed to overcome the limitations of existing isochronal 3D mapping systems by representing the intracardiac electrogram as a dynamic bar on a surface bipolar voltage map that changes in height according to the electrogram voltage-time relationship, relative to a fiduciary point.

OBJECTIVE:

We tested the hypothesis that standard approaches to atrial tachycardia CARTO™ activation maps were inadequate for RM creation and interpretation. From the results, we aimed to develop an algorithm to optimize RMs for future prospective testing on a clinical RM platform.

METHODS:

CARTO-XP™ activation maps from atrial tachycardia ablations were reviewed by two blinded assessors on an off-line RM workstation. Ripple Maps were graded according to a diagnostic confidence scale (Grade I - high confidence with clear pattern of activation through to Grade IV - non-diagnostic). The RM-based diagnoses were corroborated against the clinical diagnoses.

RESULTS:

43 RMs from 14 patients were classified as Grade I (5 [11.5%]); Grade II (17 [39.5%]); Grade III (9 [21%]) and Grade IV (12 [28%]). Causes of low gradings/errors included the following: insufficient chamber point density; window-of-interest<100% of cycle length (CL); <95% tachycardia CL mapped; variability of CL and/or unstable fiducial reference marker; and suboptimal bar height and scar settings.

CONCLUSIONS:

A data collection and map interpretation algorithm has been developed to optimize Ripple Maps in atrial tachycardias. This algorithm requires prospective testing on a real-time clinical platform.

KEYWORDS:

Ablation; Atrial tachycardia; Mapping; Ripple Mapping

PMID:
26247796
DOI:
10.1016/j.ijcard.2015.07.017
[Indexed for MEDLINE]
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