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Ripple Frequency Determined via a Novel Algorithm is Associated with Atrial Fibrillation Termination and Freedom from Atrial Fibrillation
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  • Daniel Melby,
  • Refael Itah,
  • David Benditt,
  • Venkatakrishna Tholakanahalli,
  • Raed Abdelhadi,
  • Jay Sengupta,
  • Charles Gornick,
  • JoEllyn Moore,
  • Manjunath Pai,
  • John Zakaib
Daniel Melby
Abbott Northwestern Hospital
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Refael Itah
Biosense Webster Inc
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David Benditt
University of Minnesota Medical Center
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Venkatakrishna Tholakanahalli
Division of Cardiology, VA Medical Center, Minneapolis, MN & University of Minnesota
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Raed Abdelhadi
Abbott Northwestern Hospital
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Jay Sengupta
Minneapolis Heart Institute at Abbott Northwestern Hospital
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Charles Gornick
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital
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JoEllyn Moore
Minneapolis Heart Institute Foundation
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Manjunath Pai
Abbott Northwestern Hospital
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John Zakaib
Minneapolis Heart Institute Foundation
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Abstract

Background: Persistent atrial fibrillation (PsAF) is a complex arrhythmia and achieving a high rate of freedom from recurrence of AF by catheter ablation has been challenging. CARTO® Ripple map has previously been identified as one possible method to improve ablation outcomes. Objective: To evaluate the relationship of AF termination and 18-month freedom from AF with Ripple Frequency measured via a novel CARTO® software algorithm. Methods: PsAF patients who underwent first time ablation were included. PV antral isolation was performed followed by locations with visually identified fast Ripple activations until AF termination. Patients were followed for 18 months. Retrospective analysis was performed using a novel CARTO® software algorithm to analyze Ripple Frequency. The Ripple Frequency algorithm quantifies amplitude changes in the bipolar electrogram over time. Results: 82 maps from 54 patients (mean age 65.4, 67% male) were analyzed. The top quartile of Ripple Frequency corresponded to a visual reference with 96.1% sensitivity and 84.7% specificity. AF terminated during ablation in 90.7% of patients: PV antrum alone (14.8%), or PV plus non-antral sites (85.2%). The top quartile of Ripple frequency was present in non-antral sites associated with AF termination with an 89.6% sensitivity and 87.7% specificity. After 18 months and a mean of 1.2 ablations, 53/54 patients (98.1%) were free of AF and 85.2% were free of any atrial arrhythmia. Conclusion: Automated analysis of CARTO® Ripple Frequency demonstrated good sensitivity and specificity for detecting atrial regions in PsAF where ablation is associated with AF termination and freedom from AF after 18 months.