Ripple-AT Study: A Multicenter and Randomized Study Comparing 3D Mapping Techniques During Atrial Tachycardia...

Area of Science:

• Electrophysiology
• Cardiovascular Medicine
• Medical Technology

Background:

• Atrial tachycardia (AT) diagnosis can be challenging.
• Conventional local activation time (LAT) mapping requires electrogram annotation.
• Ripple mapping (RM) offers an alternative approach to AT mapping without electrogram annotation.

Purpose of the Study:

• To compare the efficacy of ripple mapping (RM) versus local activation time (LAT) mapping for diagnosing and guiding ablation of atrial tachycardia (AT).
• To determine if RM is superior to LAT mapping in achieving successful AT termination with the initial ablation strategy.

Main Methods:

• A randomized, multicenter study comparing RM and LAT mapping in patients with AT.
• Patients were randomized to either RM or LAT mapping using the CARTO3v4 CONFIDENSE system.
• The primary endpoint was AT termination using a planned ablation lesion set, with defined criteria for failure.

Main Results:

• Ripple mapping (RM) demonstrated superior performance, with 90% of patients achieving the primary endpoint compared to 71% with LAT mapping (P=0.045).
• RM enabled successful termination without entrainment in 74% of cases, versus 44% with LAT mapping (P=0.01).
• Crossover analysis showed LAT patients benefited from switching to RM, while RM patients did not benefit from switching to LAT.

Conclusions:

• Ripple mapping (RM) is superior to LAT mapping on the CARTO3v4 CONFIDENSE system for guiding atrial tachycardia ablation.
• RM facilitates AT termination with the first ablation set and reduces the need for entrainment maneuvers for diagnosis.