Ripple-Mapping for the Detection of Long Duration Action Potential Areas in Patients with Brugada Syndrome

Abstract

Purpose: Catheter ablation has been recently utilised in patients with Brugada syndrome to prevent ventricular arrhythmias. We hypothesized whether a mapping algorithm "Ripple-mapping" would be able to rapidly identify the areas of long-duration multicomponent electrograms which constitute the targets for ablation for an automated strategy. Methods:Ripple-Mapping analysis was performed in all patients undergoing catheter ablation of Brugada syndrome in 2 centers. The activity propagation pattern determined by Ripple-Mapping was assessed, and areas of long duration potentials identified by visual inspection. The area of interest with long-duration potentials was correlated with the location of the ablation lesions.Results: Detection of long duration potentials was possible in all four patients in this analysis. Points marking the ablation area in 2 patients were a perfect match to abnormal areas identified by Ripple-mapping. However, in 2 patients Ripple-mapping identified additional sites of long duration potentials which were not ablated. Acute and mid-term normalization of the ECG pattern was observed in three patients, and all these were free from arrhythmia relapse during a 10.3±3.2 months follow-up. In one patient, who had no ECG normalization and had arrhythmia relapse, the ablated area corresponded to <25% of the Ripple-map region of interest. Conclusions:This study shows the potential use of Ripple-mapping for identifying areas of long duration multicomponent electrograms in patients with Brugada syndrome and recurrent ventricular arrhythmias. This technique enables the rapid definition of an area of interest which should then be validated by the operator before performing ablation with an end-point of ECG normalisation.

Epicardial Ablation in Brugada Syndrome

“…29 Retrospective use of this approach identified important areas which were missed for ablation in a patient who later relapsed. 31 The acute procedural endpoint for all cases was eliminated of the functional substrate and disappearance of the type-1 Brugada syndrome pattern. Most studies performed a drug challenge at the end to confirm non-inducibility of type 1 pattern after substrate ablation.…”