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Outcomes following persistent atrial fibrillation ablation using localized sources identified with Ripple map
Daniel P Melby1, Charles Gornick1, Raed Abdelhadi1
1Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota.
Journal of Cardiovascular Electrophysiology
|July 30, 2019
Summary
Ablating high-frequency ripple activation (HFRA) sites using Ripple map technology significantly improved acute termination and long-term freedom from atrial fibrillation (AF) compared to standard methods.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Technology
Background:
- Persistent atrial fibrillation (AF) ablation presents significant challenges.
- Identifying and ablating localized AF drivers is crucial for improved patient outcomes.
- Novel software algorithms like Ripple map aim to enhance AF driver localization.
Purpose of the Study:
- To evaluate the efficacy of the Ripple map algorithm in guiding ablation for persistent AF.
- To determine if regions of high-frequency ripple activation (HFRA) identified by Ripple map serve as effective ablation targets.
Main Methods:
- A comparative study involving 162 patients undergoing first-time persistent AF ablation.
- Patients were randomized into two groups: standard stepwise ablation (105 patients) or Ripple map-guided ablation (57 patients).
- Ripple map guided ablation included pulmonary vein antral isolation followed by ablation of identified HFRA sites.
Main Results:
- Acute AF termination was significantly higher in the Ripple map group (91.2%) compared to the standard group (52.4%).
- After 18 months, 98.2% of patients in the Ripple map group were free from AF, versus 81.4% in the standard group.
- No significant differences were observed in freedom from atrial tachycardia or any atrial arrhythmia between the groups.
Conclusions:
- Ablation of HFRA sites identified using Ripple map is a more effective strategy for persistent AF.
- The Ripple map approach leads to higher rates of acute AF termination and sustained freedom from AF.
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