Identification of a critical isthmus in complex macroreentrant atrial tachycardia using Ripple mapping in a patient with surgically repaired Ebstein's anomaly

Ripple mapping is a novel, three-dimensional, electroanatomic mapping tool that displays each electrogram at its corresponding 3-dimensional coordinate as a dynamic moving bar, which changes in length according to the electrogram voltage-time relationship. We present the case of a 43-year-old male p...

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Bibliographic Details
Main Authors: Gustavo Lima da Silva, Nuno Cortez-Dias, Luís Carpinteiro, João de Sousa
Format: Article
Language:English
Published: Elsevier 2019-05-01
Series:Revista Portuguesa de Cardiologia (English Edition)
Online Access:http://www.sciencedirect.com/science/article/pii/S2174204919301540
Description
Summary:Ripple mapping is a novel, three-dimensional, electroanatomic mapping tool that displays each electrogram at its corresponding 3-dimensional coordinate as a dynamic moving bar, which changes in length according to the electrogram voltage-time relationship. We present the case of a 43-year-old male patient with surgically repaired Ebstein's anomaly who previously underwent two unsuccessful ablation procedures for right atrial flutter (cavotricuspid isthmus and intercaval lines). Ripple mapping was decisive, enabling the arrhythmia mechanism to be appropriately recognized, and a distinction to be made between critical areas of the circuit and delayed activated bystander regions. Resumo: O mapeamento Ripple é uma nova ferramenta de mapeamento eletroanatómico tridimensional que permite visualizar cada eletrograma na sua coordenada 3D correspondente na forma de uma barra com movimento dinâmico que altera a sua amplitude de acordo com a relação voltagem-tempo do eletrograma. É apresentado um caso de um doente de 43 anos com anomalia de Ebstein corrigida cirurgicamente e previamente submetido a dois procedimentos de ablação por fluter auricular direito (linhas do istmo cavo-tricúspide e intercava) sem sucesso. O mapeamento Ripple foi decisivo, permitiu o reconhecimento apropriado do mecanismo da arritmia e a distinção entre as áreas críticas do circuito e áreas bystander ativadas tardiamente. Keywords: Ripple mapping, 3-dimensional mapping systems, Atrial arrhythmias, Catheter ablation, Ebstein's anomaly, Palavras-chave: Mapeamento Ripple, Sistemas de mapeamento tridimensionais, Arritmias auriculares, Ablação por cateter, Anomalia de Ebstein
ISSN:2174-2049