Application of ripple mapping with an electroanatomic mapping system for diagnosis of atrial tachycardias

J Cardiovasc Electrophysiol. 2013 Dec;24(12):1361-9. doi: 10.1111/jce.12259. Epub 2013 Oct 10.


Background: 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.

Objectives: We hypothesized that RM would be superior to established 3D activation mapping.

Methods: CARTO-XP™ 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.

Results: 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.

Conclusion: 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.

Keywords: activation mapping; atrial tachycardia; catheter ablation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Action Potentials
  • Adult
  • Aged
  • Aged, 80 and over
  • Catheter Ablation
  • Diagnostic Errors / prevention & control
  • Electrocardiography
  • Electrophysiologic Techniques, Cardiac*
  • Female
  • Heart Conduction System / physiopathology*
  • Heart Conduction System / surgery
  • Humans
  • Imaging, Three-Dimensional*
  • Male
  • Middle Aged
  • Observer Variation
  • Predictive Value of Tests
  • Reproducibility of Results
  • Retrospective Studies
  • Signal Processing, Computer-Assisted*
  • Software
  • Tachycardia, Supraventricular / diagnosis*
  • Tachycardia, Supraventricular / physiopathology
  • Tachycardia, Supraventricular / surgery
  • Time Factors