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Mapping outflow tract (OT) premature ventricular contractions (PVCs) can be difficult given a frequent mid-myocardial origin. Compared to local activation time mapping, Carto® Ripple Mapping provides visualization of both far field and near field signals independent of local annotation that may enhance PVC localization.
To evaluate the utility of Ripple mapping to localize OT PVCs.
Electroanatomic maps for consecutive OT PVC catheter ablation cases (July 2018-December 2020) were analyzed. For each PVC, we identified the earliest local activation point (EA), defined by the point of maximal -dV/dt in the unipolar electrogram (EGM) within each corresponding bipolar EGM, and the earliest Ripple signal (ERS), defined as the earliest point at which 3 grouped simultaneous Ripple bars appeared. Procedural success was defined as full suppression of the targeted PVC.
57 PVC maps were included. When ERS was in the same chamber (right ventricle, left ventricle, or coronary sinus) as EA, procedural success was 84%, versus 29% when discordant (p <0.01) (Figure). Site discordance had an odds ratio for needing multisite ablation of 7.9 (95% confidence interval 1.4-4.6; p = 0.02) and for unsuccessful procedure of 13.1 (2.2-79.9; p<0.01). Median EA-ERS distance in successful and unsuccessful cases was 4.6 mm (interquartile range 2.9, 8.5) vs 12.5 mm (7.8, 18.5); (p<0.01). Positive predictive value for successful ablation with EA-ERS distance <10mm was 90% (79-95%, p<0.01).