Dr. Shahnaz Jamil-Copley is funded by a grant (PG/10/37/28347) from the British Heart Foundation.
Application of Ripple Mapping with an Electroanatomic Mapping System for Diagnosis of Atrial Tachycardias
Version of Record online: 10 OCT 2013
© 2013 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 12, pages 1361–1369, December 2013
How to Cite
JAMIL-COPLEY, S., LINTON, N., KOA-WING, M., KOJODJOJO, P., LIM, P. B., MALCOLME-LAWES, L., WHINNETT, Z., WRIGHT, I., DAVIES, W., PETERS, N., FRANCIS, D. P. and KANAGARATNAM, P. (2013), Application of Ripple Mapping with an Electroanatomic Mapping System for Diagnosis of Atrial Tachycardias. Journal of Cardiovascular Electrophysiology, 24: 1361–1369. doi: 10.1111/jce.12259
This work was supported by the NIHR Biomedical Research Centre, and the ElectroCardioMaths Programme of the Imperial BHF Centre of Research Excellence.
Imperial College owns the Intellectual Property rights of Ripple Mapping on behalf of Dr. Kanagaratnam, Dr. Francis, and Dr. Linton.
Dr. Kanagaratnam, Dr. Francis, Dr. Linton, and Dr. Jamil-Copley have received consulting fees from Biosense Webster with regard to this software. Dr. Davies reports serving as a consultant to and is a stockholder in Rhythmia Medical. Other authors: No disclosures.
- Issue online: 2 DEC 2013
- Version of Record online: 10 OCT 2013
- Accepted manuscript online: 17 AUG 2013 10:30AM EST
- Manuscript Accepted: 12 JUL 2013
- Manuscript Revised: 17 JUN 2013
- Manuscript Received: 27 FEB 2013
- NIHR Biomedical Research Centre
- ElectroCardioMaths Programme of the Imperial BHF Centre of Research Excellence
- activation mapping;
- atrial tachycardia;
- catheter ablation
Ripple Mapping: A Novel 3D EGM Display
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.
We hypothesized that RM would be superior to established 3D activation mapping.
CARTO-XPTM 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.
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.
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.