Outcomes following persistent atrial fibrillation ablation using localized sources identified with Ripple map

Daniel P. Melby; Charles Gornick; Raed Abdelhadi; Jay Sengupta; Manju Pai; John S. Zakaib; Jo Ellyn Moore; David G. Benditt

doi:10.1111/jce.14092

Outcomes following persistent atrial fibrillation ablation using localized sources identified with Ripple map

Daniel P. Melby, Charles Gornick, Raed Abdelhadi, Jay Sengupta, Manju Pai, John S. Zakaib, Jo Ellyn Moore, David G. Benditt

Medicine - Cardiology Division

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Background: Ablation of persistent atrial fibrillation (AF) remains challenging. Identification and ablation of localized AF drivers may offer the possibility for improved outcomes. Ripple map is a novel software algorithm that may allow improved localization of possible AF drivers through the whole chamber graphical display of continuously recorded bipolar electrograms. The objective of this study was to determine whether regions of high-frequency Ripple activation (HFRA) observed on Ripple map provide useful ablation targets in patients with persistent AF. Methods and Results: Consecutive patients underwent the first-time ablation of persistent AF (n = 162) using a standard stepwise (n = 105) or a Ripple map guided approach (n = 57). Ripple map guided patients underwent pulmonary vein antral isolation followed by ablation of HFRA sites. Acute termination of AF was observed in 91.2% of the Ripple-guided patients vs 52.4% in the stepwise approach, P <.0001. Following a single ablation procedure, after 18 months 98.2% of Ripple map guided patients were free of AF, compared with 81.4% of standard stepwise ablation (P =.005). Freedom from atrial tachycardia (54.4% Ripple map vs 52.4% standard, P =.9) or any atrial arrhythmia (52.6% Ripple map vs 39.0% standard, P =.10) did not differ between the two strategies. In a subset analysis (n = 30 of 56), Ripple map regions corresponded to sites with spatiotemporal dispersion in all atrial locations. No differences were observed in the rate of procedural complications. Conclusions: Ablation of HFRA sites identified with Ripple map resulted in a higher rate of acute termination and improved freedom from AF compared to a standard stepwise approach.

Original language	English (US)
Pages (from-to)	1860-1867
Number of pages	8
Journal	Journal of cardiovascular electrophysiology
Volume	30
Issue number	10
DOIs	https://doi.org/10.1111/jce.14092
State	Published - Oct 1 2019

Bibliographical note

Funding Information:
The authors wish to thank Ross Garberich for his statistical expertise, and Dr. Kanagaratnam, Imperial College Healthcare NHS, for his development of the Ripple map algorithm. DGB is supported in part by a grant from the Dr Earl E. Bakken family in support of Heart-Brain research.

Publisher Copyright:
© 2019 The Authors. Journal of Cardiovascular Electrophysiology Published by Wiley Periodicals, Inc.

Keywords

Ripple map
atrial fibrillation
catheter ablation
outcomes

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title = "Outcomes following persistent atrial fibrillation ablation using localized sources identified with Ripple map",

abstract = "Background: Ablation of persistent atrial fibrillation (AF) remains challenging. Identification and ablation of localized AF drivers may offer the possibility for improved outcomes. Ripple map is a novel software algorithm that may allow improved localization of possible AF drivers through the whole chamber graphical display of continuously recorded bipolar electrograms. The objective of this study was to determine whether regions of high-frequency Ripple activation (HFRA) observed on Ripple map provide useful ablation targets in patients with persistent AF. Methods and Results: Consecutive patients underwent the first-time ablation of persistent AF (n = 162) using a standard stepwise (n = 105) or a Ripple map guided approach (n = 57). Ripple map guided patients underwent pulmonary vein antral isolation followed by ablation of HFRA sites. Acute termination of AF was observed in 91.2% of the Ripple-guided patients vs 52.4% in the stepwise approach, P <.0001. Following a single ablation procedure, after 18 months 98.2% of Ripple map guided patients were free of AF, compared with 81.4% of standard stepwise ablation (P =.005). Freedom from atrial tachycardia (54.4% Ripple map vs 52.4% standard, P =.9) or any atrial arrhythmia (52.6% Ripple map vs 39.0% standard, P =.10) did not differ between the two strategies. In a subset analysis (n = 30 of 56), Ripple map regions corresponded to sites with spatiotemporal dispersion in all atrial locations. No differences were observed in the rate of procedural complications. Conclusions: Ablation of HFRA sites identified with Ripple map resulted in a higher rate of acute termination and improved freedom from AF compared to a standard stepwise approach.",

keywords = "Ripple map, atrial fibrillation, catheter ablation, outcomes",

author = "Melby, {Daniel P.} and Charles Gornick and Raed Abdelhadi and Jay Sengupta and Manju Pai and Zakaib, {John S.} and Moore, {Jo Ellyn} and Benditt, {David G.}",

note = "Funding Information: The authors wish to thank Ross Garberich for his statistical expertise, and Dr. Kanagaratnam, Imperial College Healthcare NHS, for his development of the Ripple map algorithm. DGB is supported in part by a grant from the Dr Earl E. Bakken family in support of Heart-Brain research. Publisher Copyright: {\textcopyright} 2019 The Authors. Journal of Cardiovascular Electrophysiology Published by Wiley Periodicals, Inc.",

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AU - Melby, Daniel P.

AU - Gornick, Charles

AU - Abdelhadi, Raed

AU - Sengupta, Jay

AU - Pai, Manju

AU - Zakaib, John S.

AU - Moore, Jo Ellyn

AU - Benditt, David G.

N1 - Funding Information: The authors wish to thank Ross Garberich for his statistical expertise, and Dr. Kanagaratnam, Imperial College Healthcare NHS, for his development of the Ripple map algorithm. DGB is supported in part by a grant from the Dr Earl E. Bakken family in support of Heart-Brain research. Publisher Copyright: © 2019 The Authors. Journal of Cardiovascular Electrophysiology Published by Wiley Periodicals, Inc.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Background: Ablation of persistent atrial fibrillation (AF) remains challenging. Identification and ablation of localized AF drivers may offer the possibility for improved outcomes. Ripple map is a novel software algorithm that may allow improved localization of possible AF drivers through the whole chamber graphical display of continuously recorded bipolar electrograms. The objective of this study was to determine whether regions of high-frequency Ripple activation (HFRA) observed on Ripple map provide useful ablation targets in patients with persistent AF. Methods and Results: Consecutive patients underwent the first-time ablation of persistent AF (n = 162) using a standard stepwise (n = 105) or a Ripple map guided approach (n = 57). Ripple map guided patients underwent pulmonary vein antral isolation followed by ablation of HFRA sites. Acute termination of AF was observed in 91.2% of the Ripple-guided patients vs 52.4% in the stepwise approach, P <.0001. Following a single ablation procedure, after 18 months 98.2% of Ripple map guided patients were free of AF, compared with 81.4% of standard stepwise ablation (P =.005). Freedom from atrial tachycardia (54.4% Ripple map vs 52.4% standard, P =.9) or any atrial arrhythmia (52.6% Ripple map vs 39.0% standard, P =.10) did not differ between the two strategies. In a subset analysis (n = 30 of 56), Ripple map regions corresponded to sites with spatiotemporal dispersion in all atrial locations. No differences were observed in the rate of procedural complications. Conclusions: Ablation of HFRA sites identified with Ripple map resulted in a higher rate of acute termination and improved freedom from AF compared to a standard stepwise approach.

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Outcomes following persistent atrial fibrillation ablation using localized sources identified with Ripple map

Abstract

Bibliographical note

Keywords

UN SDGs

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