BACKGROUND: Three-dimensional (3D) mapping is often used to guide ablation in atrial tachycardia (AT), but maps can be susceptible to annotation and interpolation errors. Ripple Mapping (RM) is a technique that displays electrogram time-voltage data simultaneously as dynamic bars on the surface shell to overcome these limitations. OBJECTIVES: We hypothesized that RM would be superior to established 3D activation mapping. METHODS: CARTO-XP™ maps of ATs were collected without any manual annotation and studied on a CARTO-based offline RM system. Paired unannotated CARTO-XP and Ripple Maps were presented to experienced CARTO users with limited RM training. These assessors were allowed to annotate the CARTO-XP maps, but were blinded to conventional EP data. RESULTS: CARTO-XP maps of AT (10 patients) were studied in RM format and the diagnosis was confirmed by entrainment in all cases and with termination of tachycardia in 9/10 cases. Blinded assessors (n = 11) reached the correct diagnosis using RM in 35/44 (80%) compared to 22/44 (50%) using CARTO-XP (P = 0.029). The time to the correct diagnosis was also shorter with RM (136 seconds vs. 212 seconds; P = 0.022). The causes of diagnostic errors using RM (insufficient point density, particularly in low-voltage areas, and the operator not assessing all available views) were overcome with an improved MatLab version showing both scar and dynamic bars on the same shell. CONCLUSION: RM does not need any manual annotation of local activation time and enables rapid diagnosis of AT with higher diagnostic accuracy than conventional 3D activation mapping.
BACKGROUND: Three-dimensional (3D) mapping is often used to guide ablation in atrial tachycardia (AT), but maps can be susceptible to annotation and interpolation errors. Ripple Mapping (RM) is a technique that displays electrogram time-voltage data simultaneously as dynamic bars on the surface shell to overcome these limitations. OBJECTIVES: We hypothesized that RM would be superior to established 3D activation mapping. METHODS: CARTO-XP™ maps of ATs were collected without any manual annotation and studied on a CARTO-based offline RM system. Paired unannotated CARTO-XP and Ripple Maps were presented to experienced CARTO users with limited RM training. These assessors were allowed to annotate the CARTO-XP maps, but were blinded to conventional EP data. RESULTS: CARTO-XP maps of AT (10 patients) were studied in RM format and the diagnosis was confirmed by entrainment in all cases and with termination of tachycardia in 9/10 cases. Blinded assessors (n = 11) reached the correct diagnosis using RM in 35/44 (80%) compared to 22/44 (50%) using CARTO-XP (P = 0.029). The time to the correct diagnosis was also shorter with RM (136 seconds vs. 212 seconds; P = 0.022). The causes of diagnostic errors using RM (insufficient point density, particularly in low-voltage areas, and the operator not assessing all available views) were overcome with an improved MatLab version showing both scar and dynamic bars on the same shell. CONCLUSION: RM does not need any manual annotation of local activation time and enables rapid diagnosis of AT with higher diagnostic accuracy than conventional 3D activation mapping.
Authors: Steven E Williams; Caroline H Roney; Adam Connolly; Iain Sim; John Whitaker; Daniel O'Hare; Irum Kotadia; Louisa O'Neill; Cesare Corrado; Martin Bishop; Steven A Niederer; Matt Wright; Mark O'Neill; Nick W F Linton Journal: Front Physiol Date: 2021-02-26 Impact factor: 4.566
Authors: Tobias Oesterlein; Daniel Frisch; Axel Loewe; Gunnar Seemann; Claus Schmitt; Olaf Dössel; Armin Luik Journal: Biomed Res Int Date: 2016-12-13 Impact factor: 3.411