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Isthmus sites identified by Ripple Mapping are usually anatomically stable: A novel method to guide atrial substrate ablation?

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Title: Isthmus sites identified by Ripple Mapping are usually anatomically stable: A novel method to guide atrial substrate ablation?
Authors: Luther, V
Qureshi, N
Lim, PB
Koa-Wing, M
Jamil-Copley, S
Ng, FS
Whinnett, Z
Davies, DW
Peters, NS
Kanagaratnam, P
Linton, N
Item Type: Journal Article
Abstract: BACKGROUND: Postablation reentrant ATs depend upon conducting isthmuses bordered by scar. Bipolar voltage maps highlight scar as sites of low voltage, but the voltage amplitude of an electrogram depends upon the myocardial activation sequence. Furthermore, a voltage threshold that defines atrial scar is unknown. We used Ripple Mapping (RM) to test whether these isthmuses were anatomically fixed between different activation vectors and atrial rates. METHODS: We studied post-AF ablation ATs where >1 rhythm was mapped. Multipolar catheters were used with CARTO Confidense for high-density mapping. RM visualized the pattern of activation, and the voltage threshold below which no activation was seen. Isthmuses were characterized at this threshold between maps for each patient. RESULTS: Ten patients were studied (Map 1 was AT1; Map 2: sinus 1/10, LA paced 2/10, AT2 with reverse CS activation 3/10; AT2 CL difference 50 ± 30 ms). Point density was similar between maps (Map 1: 2,589 ± 1,330; Map 2: 2,214 ± 1,384; P  =  0.31). RM activation threshold was 0.16 ± 0.08 mV. Thirty-one isthmuses were identified in Map 1 (median 3 per map; width 27 ± 15 mm; 7 anterior; 6 roof; 8 mitral; 9 septal; 1 posterior). Importantly, 7 of 31 (23%) isthmuses were unexpectedly identified within regions without prior ablation. AT1 was treated following ablation of 11/31 (35%) isthmuses. Of the remaining 20 isthmuses, 14 of 16 isthmuses (88%) were consistent between the two maps (four were inadequately mapped). Wavefront collision caused variation in low voltage distribution in 2 of 16 (12%). CONCLUSIONS: The distribution of isthmuses and nonconducting tissue within the ablated left atrium, as defined by RM, appear concordant between rhythms. This could guide a substrate ablative approach.
Issue Date: 17-Jan-2018
Date of Acceptance: 18-Dec-2017
URI: http://hdl.handle.net/10044/1/57115
DOI: https://dx.doi.org/10.1111/jce.13425
ISSN: 1045-3873
Publisher: Wiley
Start Page: 404
End Page: 411
Journal / Book Title: Journal of Cardiovascular Electrophysiology
Volume: 29
Issue: 3
Copyright Statement: © 2018 Wiley Periodicals, Inc. This is the peer reviewed version of the following article: Luther V, Qureshi N, Lim PB, et al. Isthmus sites identified by Ripple Mapping are usually anatomically stable: A novel method to guide atrial substrate ablation? J Cardiovasc Electrophysiol. 2018;1–8, which has been published in final form at https://dx.doi.org/10.1111/jce.13425. This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.
Sponsor/Funder: British Heart Foundation
British Heart Foundation
Funder's Grant Number: FS/13/44/30291
FS/15/25/31423
Keywords: 3D mapping
CARTO
ablation
atrial tachycardia
scar
1102 Cardiovascular Medicine And Haematology
Cardiovascular System & Hematology
Publication Status: Published
Appears in Collections:Faculty of Engineering
Bioengineering
National Heart and Lung Institute
Faculty of Medicine



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