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

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Title: A diagnostic algorithm to optimize data collection and interpretation of Ripple Maps in atrial tachycardias
Authors: Koa-Wing, M
Nakagawa, H
Luther, V
Jamil-Copley, S
Linton, N
Sandler, B
Qureshi, N
Peters, NS
Davies, DW
Francis, DP
Jackman, W
Kanagaratnam, P
Item Type: Journal Article
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.
Issue Date: 23-Jul-2015
Date of Acceptance: 6-Jul-2015
URI: http://hdl.handle.net/10044/1/39093
DOI: http://dx.doi.org/10.1016/j.ijcard.2015.07.017
ISSN: 1874-1754
Publisher: Elsevier
Start Page: 391
End Page: 400
Journal / Book Title: International Journal of Cardiology
Volume: 199
Copyright Statement: © 2015 Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor/Funder: British Heart Foundation
British Heart Foundation
British Heart Foundation
British Heart Foundation
Funder's Grant Number: RG/10/11/28457
PG/10/37/28347
FS/10/38/28268
FS/15/12/31239
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Mapping
Atrial tachycardia
Ablation
Ripple Mapping
VENTRICULAR-TACHYCARDIA
MAPPING SYSTEM
CATHETER ABLATION
CIRCUIT
IDENTIFICATION
FIBRILLATION
FLUTTER
SCAR
Aged
Algorithms
Catheter Ablation
Cicatrix
Electrophysiologic Techniques, Cardiac
Female
Heart Conduction System
Humans
Image Interpretation, Computer-Assisted
Male
Middle Aged
Prospective Studies
Tachycardia, Ectopic Atrial
Tachycardia, Supraventricular
Cardiovascular System & Hematology
1102 Cardiovascular Medicine And Haematology
Publication Status: Published
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine



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