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Cardiac ripple mapping: A novel three-dimensional visualization method for use with electroanatomic mapping of cardiac arrhythmias

Published:September 07, 2009DOI:https://doi.org/10.1016/j.hrthm.2009.08.038

      Background

      Mapping of regular cardiac arrhythmias is frequently performed using sequential point-by-point annotation of local activation relative to a fixed timing reference. Assigning a single activation for each electrogram is unreliable for fragmented, continuous, or double potentials. Furthermore, these informative electrogram characteristics are lost when only a single timing point is assigned to generate activation maps.

      Objective

      The purpose of this study was to develop a novel method of electrogram visualization conveying both timing and morphology as well as location of each point within the chamber being studied.

      Methods

      Data were used from six patients who had undergone electrophysiological study with the Carto electroanatomic mapping system. Software was written to construct a three-dimensional surface from the imported electrogram locations. Electrograms were time gated and displayed as dynamic bars that extend out from this surface, changing in length and color according to the local electrogram voltage-time relationship to create a ripple map of cardiac activation.

      Results

      Ripple maps were successfully constructed for sinus rhythm (n = 1), atrial tachycardia (n = 3), and ventricular tachycardia (n = 2), simultaneously demonstrating voltage and timing information for all six patients. They showed low-amplitude continuous activity in four of five tachycardias at the site of successful ablation, consistent with a reentrant mechanism.

      Conclusion

      Ripple mapping allows activation of the myocardium to be tracked visually without prior assignment of local activation times and without interpolation into unmapped regions. It assists the identification of tachycardia mechanism and optimal ablation site, without the need for an experienced computer-operating assistant.

      Keywords

      Abbreviations:

      AF (atrial fibrillation), CTI (cavotricuspid isthmus), ECG (electrocardiogram), LA (left atrium), RA (right atrium), RV (right ventricle), VT (ventricular tachycardia)
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      References

        • Tai C.T.
        • Chen S.A.
        • Chiang C.E.
        • et al.
        Long-term outcome of radiofrequency catheter ablation for typical atrial flutter: risk prediction of recurrent arrhythmias.
        J Cardiovasc Electrophysiol. 1998; 9: 115-121
        • Dixit S.
        • Callans D.J.
        Mapping for ventricular tachycardia.
        Card Electrophysiol Rev. 2002; 6: 436-441
        • Marchlinski F.
        • Callans D.
        • Gottlieb C.
        • et al.
        Magnetic electroanatomical mapping for ablation of focal atrial tachycardias.
        Pacing Clin Electrophysiol. 1998; 21: 1621-1635
        • Earley M.J.
        • Showkathali R.
        • Alzetani M.
        • et al.
        Radiofrequency ablation of arrhythmias guided by non-fluoroscopic catheter location: a prospective randomized trial.
        Eur Heart J. 2006; 27: 1223-1229
        • Nakagawa H.
        • Jackman W.M.
        Use of a 3-dimensional electroanatomical mapping system for catheter ablation of macroreentrant right atrial tachycardia following atriotomy.
        J Electrocardiol. 1999; 32: 16-21
        • Nakagawa H.
        • Shah N.
        • Matsudaira K.
        • et al.
        Characterization of reentrant circuit in macroreentrant right atrial tachycardia after surgical repair of congenital heart disease: isolated channels between scars allow “focal” ablation.
        Circulation. 2001; 103: 699-709
        • Schilling R.J.
        • Peters N.S.
        • Davies D.W.
        Mapping and ablation of ventricular tachycardia with the aid of a non-contact mapping system.
        Heart. 1999; 81: 570-575
        • Shah D.C.
        • Jais P.
        • Haissaguerre M.
        • et al.
        Three-dimensional mapping of the common atrial flutter circuit in the right atrium.
        Circulation. 1997; 96: 3904-3912
        • Stevenson W.G.
        • Delacretaz E.
        • Friedman P.L.
        • Ellison K.E.
        Identification and ablation of macroreentrant ventricular tachycardia with the CARTO electroanatomical mapping system.
        Pacing Clin Electrophysiol. 1998; 21: 1448-1456
        • Shah D.
        • Sunthorn H.
        • Burri H.
        • et al.
        Narrow, slow-conducting isthmus dependent left atrial reentry developing after ablation for atrial fibrillation: ECG characterization and elimination by focal RF ablation.
        J Cardiovasc Electrophysiol. 2006; 17: 508-515
        • de Groot N.M.
        • Schalij M.J.
        • Zeppenfeld K.
        • et al.
        Voltage and activation mapping: how the recording technique affects the outcome of catheter ablation procedures in patients with congenital heart disease.
        Circulation. 2003; 108: 2099-2106
        • Khoury D.S.
        • Taccardi B.
        • Lux R.L.
        • Ershler P.R.
        • Rudy Y.
        Reconstruction of endocardial potentials and activation sequences from intracavitary probe measurements.
        Circulation. 1995; 91: 845-863
        • Chinitz L.A.
        • Sethi J.S.
        How to perform noncontact mapping.
        Heart Rhythm. 2006; 3: 120-123
        • Gregory R.L.
        The Medawar Lecture 2001 knowledge for vision: vision for knowledge.
        Philos Trans R Soc Lond B Biol Sci. 2005; 360: 1231-1251
        • Knecht S.
        • Hocini M.
        • Wright M.
        • et al.
        Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation.
        Eur Heart J. 2008; 29: 2359-2366
        • Lellouche N.
        • Jais P.
        • Nault I.
        • et al.
        Early recurrences after atrial fibrillation ablation: prognostic value and effect of early reablation.
        J Cardiovasc Electrophysiol. 2008; 19: 599-605
        • Weerasooriya R.
        • Jais P.
        • Wright M.
        • et al.
        Catheter ablation of atrial tachycardia following atrial fibrillation ablation.
        J Cardiovasc Electrophysiol. 2009; 20: 833-838
        • Harada T.
        • Stevenson W.G.
        • Kocovic D.Z.
        • Friedman P.L.
        Catheter ablation of ventricular tachycardia after myocardial infarction: relation of endocardial sinus rhythm late potentials to the reentry circuit.
        J Am Coll Cardiol. 1997; 30: 1015-1023