Differentiating border-zone tissue from post-infarct scar using ripple mapping during VT ablation

• Published in: Europace (London, England) England), 2022-05, Vol.24 (Supplement_1)
• Main Authors: Khanra, D, Calvert, P, Wright, P, Hughes, S, Mahida, S, Hall, M, Todd, D, Gupta, D, Luther, V
• Format: Article
• Language: English
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euac053.352

Abstract Funding Acknowledgements Type of funding sources: None. Background Areas of post-infarct ventricular scar and border-zone slow conduction are often highlighted on a bipolar voltage map with generalized values 0.5mV–1.5mV. The true voltage that differentiates regions of conducting from non-conducting tissue is unknown. Ripple Mapping (RM)displays allows conducting tissue to be seen as areas supporting Ripple activation, and non-conducting tissue as areas devoid of Ripple activation. Purpose We describe application of Ripple Maps to differentiate areas of scar from conducting tissue during ischemic VT ablation. Methods Dense bipolar voltage maps were created (Pentaray catheter, pacing 80-100bpm) and presented as a single value (e.g. 0.5mV-0.5mV) to binarize the color display (red and purple). RMs were superimposed on the voltage map and played above a pre-set noise threshold (>0.05mV). The voltage map mV limit was sequentially reduced ("border-zone threshold") until only those areas devoid of Ripple bars appeared red. The surrounding border-zone supporting ripple activation thus appeared purple. We performed off-line analysis of border-zone voltage thresholds from a series of RM guided VT ablations. Results 10 consecutive patients (LVEF 32.3±7.5%) with remote myocardial infarction underwent VT ablation (median 19days (IQR 8-33) since last VT). Bipolar voltage mapping (5873±2841 points, median shell area 224cm2), revealed voltages