{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:21:26Z","timestamp":1762507286455,"version":"3.37.3"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,2,1]],"date-time":"2018-02-01T00:00:00Z","timestamp":1517443200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"British Heart Foundation Clinical Research Training Fellowship","award":["FS\/15\/12\/31239"],"award-info":[{"award-number":["FS\/15\/12\/31239"]}]},{"name":"British Heart Foundation Intermediate Clinical Research Fellowship","award":["FS\/15\/25\/31423"],"award-info":[{"award-number":["FS\/15\/25\/31423"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Postablation reentrant ATs depend upon conducting isthmuses bordered by scar. Bipolar voltage maps highlight scar as sites of low voltage, but the voltage amplitude of an electrogram depends upon the myocardial activation sequence. Furthermore, a voltage threshold that defines atrial scar is unknown. We used Ripple Mapping (RM) to test whether these isthmuses were anatomically fixed between different activation vectors and atrial rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We studied post\u2010AF ablation ATs where\u00a0&gt;1 rhythm was mapped. Multipolar catheters were used with CARTO Confidense for high\u2010density mapping. RM visualized the pattern of activation, and the voltage threshold below which no activation was seen. Isthmuses were characterized at this threshold between maps for each patient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ten patients were studied (Map 1 was AT1; Map 2: sinus 1\/10, LA paced 2\/10, AT2 with reverse CS activation 3\/10; AT2 CL difference 50 \u00b1 30\u00a0ms). Point density was similar between maps (Map 1: 2,589 \u00b1 1,330; Map 2: 2,214 \u00b1 1,384; P\u00a0\u00a0=\u00a0\u00a00.31). RM activation threshold was 0.16\u00a0\u00b1\u00a00.08\u00a0mV. Thirty\u2010one isthmuses were identified in Map 1 (median 3 per map; width 27 \u00b1 15\u00a0mm; 7 anterior; 6 roof; 8 mitral; 9 septal; 1 posterior). Importantly, 7 of 31 (23%) isthmuses were unexpectedly identified within regions without prior ablation. AT1 was treated following ablation of 11\/31 (35%) isthmuses. Of the remaining 20 isthmuses, 14 of 16 isthmuses (88%) were consistent between the two maps (four were inadequately mapped). Wavefront collision caused variation in low voltage distribution in 2 of 16 (12%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The distribution of isthmuses and nonconducting tissue within the ablated left atrium, as defined by RM, appear concordant between rhythms. This could guide a substrate ablative approach.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.13425","type":"journal-article","created":{"date-parts":[[2018,1,17]],"date-time":"2018-01-17T11:45:05Z","timestamp":1516189505000},"page":"404-411","source":"Crossref","is-referenced-by-count":7,"title":["Isthmus sites identified by Ripple Mapping are usually anatomically stable: A novel method to guide atrial substrate ablation?"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3274-7128","authenticated-orcid":false,"given":"Vishal","family":"Luther","sequence":"first","affiliation":[{"name":"Imperial College Healthcare  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norman","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phang Boon","family":"Lim","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Koa\u2010Wing","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahnaz","family":"Jamil\u2010Copley","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fu Siong","family":"Ng","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary","family":"Whinnett","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. Wyn","family":"Davies","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas S.","family":"Peters","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prapa","family":"Kanagaratnam","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick","family":"Linton","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,2]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9592.2001.01334.x"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2015.09.033"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000074280.62478.E1"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2008.01373.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ihj.2013.12.039"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.116.004724"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.07.044"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eus312"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2005.00308.x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.103.5.699"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2006.00413.x"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eum055"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.25.2928"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.107.748160"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.02.029"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2013.02.020"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.116.004155"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.09.062"},{"key":"e_1_2_8_20_1","first-page":"e003582","article-title":"A prospective study of ripple mapping in atrial tachycardias: A novel approach to interpreting activation in low\u2010voltage areas","volume":"9","author":"Luther V","year":"2017","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13308"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2009.08.038"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.07.017"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12259"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13282"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.115.003841"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/pace.12408"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.115.002962"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.113.001251"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12870"}],"container-title":["Journal of Cardiovascular Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjce.13425","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.13425","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T22:12:53Z","timestamp":1695679973000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jce.13425"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2]]},"references-count":29,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,3]]}},"alternative-id":["10.1111\/jce.13425"],"URL":"https:\/\/doi.org\/10.1111\/jce.13425","archive":["Portico"],"relation":{},"ISSN":["1045-3873","1540-8167"],"issn-type":[{"type":"print","value":"1045-3873"},{"type":"electronic","value":"1540-8167"}],"subject":[],"published":{"date-parts":[[2018,2]]}}}