Isthmus sites identified by Ripple Mapping are usually anatomically stable: A novel method to guide atrial substrate ablation?

Isthmus sites identified by Ripple Mapping are usually anatomically stable: A novel method to... 1INTRODUCTIONElectrophysiologists commonly use bipolar voltage maps to highlight areas of low voltage that might be considered as scar or electrically inert tissue. It is frequently these areas that form the substrate for reentrant arrhythmias, and therefore they may be a target for ablation. In cases of ventricular tachycardia, there is consensus that substrate modification is appropriate even after successful ablation of the presenting tachycardia. However, in the atria it is unclear how to assess the arrhythmia substrate based upon electrogram recordings.The mechanism of atrial tachycardia (AT) is often iatrogenic in origin—either due to previous atrial fibrillation (AF) ablation or cardiac surgery. Bipolar voltage maps during tachycardia may help to identify isthmuses of conducting tissue bordered by scar that support activation. Whether the same scar distribution is seen with a change in activation vector or rate has not been studied in patients with AT following AF ablation. This is important, as if the isthmus locations remain concordant independent of the rhythm mapped, then this could guide substrate ablation outside of tachycardia for symptomatic patients noninducible on the day of their procedure or even at the time of their initial AF ablation procedure.Such an empirical ablation approach requires an accurate method http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Cardiovascular Electrophysiology Wiley

Isthmus sites identified by Ripple Mapping are usually anatomically stable: A novel method to guide atrial substrate ablation?