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Ripple mapping-guided atrial tachycardia ablation following open-heart surgery

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Abstract

Ripple mapping can make the visualization of activation conduction on a 3-dimensional voltage map and is useful tool for scar-related organized atrial tachycardia (AT). This study sought to assess the efficacy of ripple mapping for interpreting reentrant circuits and critical isthmus in postoperative ATs. 34 consecutive patients with a history of mitral valve surgery (mean age, 54.5 ± 12.4 years) underwent high density (HD) RM during ATs with CARTO3v4 CONFIDENSE system. The voltage activation threshold was determined by RM over a bipolar voltage map. The identification of underlying mechanisms and ablation setting was based on RM without reviewing activation mapping. A total of 41 ATs (35 spontaneous, 6 induced) were characterized. 39 reentry circuits were successfully mapped (cycle length, 256 ± 43 ms). Of the 41 ATs, 28 were confirmed by ripple mapping alone (68%), and 12 (29%) by ripple mapping and entrainment mapping. Of 12 ATs in the left atrium, 9 (75%) needed entrainment to confirm, compared with 5 (17.8%) in the right atrium. Primary endpoint after initial ablation set was achieved in 32 of the 34 patients (94.1%). Freedom from atrial arrhythmias was 79.4% after the follow-up of 12 ± 5 months. Of the seven patients with recurrence, three underwent the repeated catheter ablation. Ripple mapping precisely delineated reentrant circuits in post-cardiac surgery AT resulting in a high success rate of ablation. Entrainment maneuvers remain useful for elucidation of complex AT circuits.

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Author notes

  1. Wenzhi Shen and Yu Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing, 210008, China

    Wenzhi Shen, Yu Liu, Jian Bai, Zheng Chen, Xiaohong Li, Rongfang Lan, Zhonglin Han, Hongsong Yu, Wenqing Ji, Biao Xu & Wei Xu

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  1. Wenzhi Shen
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  2. Yu Liu
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  3. Jian Bai
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Correspondence to Wei Xu.

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Shen, W., Liu, Y., Bai, J. et al. Ripple mapping-guided atrial tachycardia ablation following open-heart surgery. Heart Vessels 36, 1016–1026 (2021). https://doi.org/10.1007/s00380-021-01772-8

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