B-PO03-088 ATRIAL FIBRILLATION TERMINATION AND FREEDOM FROM ATRIAL FIBRILLATION IS ASSOCIATED WITH ABLATION OF ATRIAL REGIONS WITH HIGHER RIPPLE FREQUENCY

Abstract

Persistent atrial fibrillation (AF) is a complex arrhythmia with multiple pathophysiologic mechanisms. Achieving a high rate of freedom from AF post ablation has been challenging. Carto® Ripple map has previously been identified as one possible method to improve ablation outcomes. The purpose of this study was to evaluate a novel CARTO® software algorithm based on CARTO® Ripple map for automated detection of visually identified high Ripple frequency locations, and the relationship of these sites to AF termination and 18 month freedom from AF. Consecutive patients underwent first time ablation for persistent AF. A high-density Ripple map was created using a Pentaray catheter. If AF did not terminate with pulmonary vein antral isolation, ablation was performed at sites with visually identified fast Ripple activations until AF termination, a protocol previously described and published by us. Patients were followed 18 months for rhythm outcome. Retrospectively analysis was then performed using a novel CARTO® software algorithm developed to analyze Ripple frequency, defined as the number of Ripple identified changes in dV/dT per second. A total of 69 maps from 38 patients (mean age 65.6, 65.8% male) were analyzed. A mean of 11.8 ± 4.9 electrograms per cm2 were present on which the automated Ripple Frequency maps were generated. The Ripple frequency ranged from 0 to 140 Ripple activations per second and the top quartile of Ripple frequency corresponded to a visual reference with 95.0% sensitivity and 88.4% specificity. AF was observed to terminate with ablation in 94.7% of patients; PV antrum alone (21.1%), or PV plus non antral sites (78.9%). The three most common non-PV antral locations were LA septum 66.7%, LA roof 61.1%, and Inferior LA 38.9%. The top quartile of Ripple frequency was present in non-PV sites necessary for AF termination with an 89.6% sensitivity and 91.4% specificity. On follow up of 18 months, 37 of 38 patients (97.4%) were free of AF. This novel algorithm for automated analysis of CARTO® Ripple frequency demonstrated a good sensitivity and specificity for detecting atrial regions in persistent AF where ablation is associated with both termination and a high freedom from AF after 18 months.