{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T02:44:32Z","timestamp":1770691472543,"version":"3.49.0"},"reference-count":23,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T00:00:00Z","timestamp":1673481600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Ventricular scar is traditionally highlighted on a bipolar voltage (BiVolt) map in areas of myocardium &lt;0.50\u2009mV. We describe an alternative approach using Ripple Mapping (RM) superimposed onto a BiVolt map to differentiate postinfarct scar from conducting borderzone (BZ) during ventricular tachycardia\u00a0(VT) ablation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifteen consecutive patients (left ventricular ejection fraction 30\u2009\u00b1\u20097%) underwent endocardial left ventricle pentaray mapping (median 5148 points) and ablation targeting areas of late Ripple activation. BiVolt maps were studied offline at initial voltage of 0.50\u20130.50\u2009mV to binarize the color display (red and purple). RMs were superimposed, and the BiVolt limits were sequentially reduced until only areas devoid of Ripple bars appeared red, defined as RM\u2010scar. The surrounding area supporting conducting Ripple wavefronts in tissue &lt;0.50\u2009mV defined the RM\u2010BZ.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>RM\u2010scar was significantly smaller than the traditional 0.50\u2009mV cutoff (median 4% vs. 12% shell area, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). 65\u2009\u00b1\u200916% of tissue &lt;0.50\u2009mV supported Ripple activation within the RM\u2010BZ. The mean BiVolt threshold that differentiated RM\u2010scar from BZ tissue was 0.22\u2009\u00b1\u20090.07\u2009mV, though this ranged widely (from 0.12 to 0.35\u2009mV). In this study, septal infarcts (7\/15) were associated with more rapid VTs (282 vs. 347\u2009ms, <jats:italic>p<\/jats:italic>\u2009=\u2009.001), and had a greater proportion of RM\u2010BZ to RM\u2010scar (median ratio 3.2 vs. 1.2, <jats:italic>p<\/jats:italic>\u2009=\u2009.013) with faster RM\u2010BZ conduction speed (0.72 vs. 0.34\u2009m\/s, <jats:italic>p<\/jats:italic>\u2009=\u2009.001). Conversely, scars that supported hemodynamically stable sustained VT (6\/15) were slower (367\u2009\u00b1\u200938\u2009ms), had a smaller proportion of RM\u2010BZ to RM\u2010scar (median ratio 1.2 vs. 3.2, <jats:italic>p<\/jats:italic>\u2009=\u2009.059), and slower RM\u2010BZ conduction speed (0.36 vs. 0.63\u2009m\/s, <jats:italic>p<\/jats:italic>\u2009=\u2009.036). RM guided ablation collocated within 66\u2009\u00b1\u200920% of RM\u2010BZ, most concentrated around the RM\u2010scar perimeter, with significant VT reduction (median 4.0 episodes preablation vs. 0 post, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) at 11\u2009\u00b1\u20096 months follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Postinfarct scars appear significantly smaller than traditional 0.50\u2009mV cut\u2010offs suggest, with voltage thresholds unique to each patient.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15766","type":"journal-article","created":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T16:40:35Z","timestamp":1670431235000},"page":"664-672","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["An approach to help differentiate postinfarct scar from borderzone tissue using Ripple Mapping during ventricular tachycardia ablation"],"prefix":"10.1111","volume":"34","author":[{"given":"Dibbendhu","family":"Khanra","sequence":"first","affiliation":[{"name":"Liverpool Heart &amp; Chest Hospital Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8401-4033","authenticated-orcid":false,"given":"Peter","family":"Calvert","sequence":"additional","affiliation":[{"name":"Liverpool Heart &amp; Chest Hospital Liverpool UK"},{"name":"Liverpool Centre of Cardiovascular Sciences University of Liverpool Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Hughes","sequence":"additional","affiliation":[{"name":"Liverpool Heart &amp; Chest Hospital Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johan","family":"Waktare","sequence":"additional","affiliation":[{"name":"Liverpool Heart &amp; Chest Hospital Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3520-6124","authenticated-orcid":false,"given":"Simon","family":"Modi","sequence":"additional","affiliation":[{"name":"Liverpool Heart &amp; Chest Hospital Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Hall","sequence":"additional","affiliation":[{"name":"Liverpool Heart &amp; Chest Hospital Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derick","family":"Todd","sequence":"additional","affiliation":[{"name":"Liverpool Heart &amp; Chest Hospital Liverpool UK"},{"name":"Liverpool Centre of Cardiovascular Sciences University of Liverpool Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saagar","family":"Mahida","sequence":"additional","affiliation":[{"name":"Liverpool Heart &amp; Chest Hospital Liverpool UK"},{"name":"Liverpool Centre of Cardiovascular Sciences University of Liverpool Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3490-090X","authenticated-orcid":false,"given":"Dhiraj","family":"Gupta","sequence":"additional","affiliation":[{"name":"Liverpool Heart &amp; Chest Hospital Liverpool UK"},{"name":"Liverpool Centre of Cardiovascular Sciences University of Liverpool Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3274-7128","authenticated-orcid":false,"given":"Vishal","family":"Luther","sequence":"additional","affiliation":[{"name":"Liverpool Heart &amp; Chest Hospital Liverpool UK"},{"name":"Liverpool Centre of Cardiovascular Sciences University of Liverpool Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,1,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2021.08.001"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.11.1288"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2011.02246.x"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.115.003841"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12761"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2009.08.038"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.114.001827"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13819"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2021.05.016"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.115.003582"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13425"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.116.004072"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.03.044"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.02.031"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000145544.35565.47"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2015.09.001"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.116.004155"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13767"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2017.12.005"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.050363"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.042423"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.114.002310"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.12.044"}],"container-title":["Journal of Cardiovascular Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.15766","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jce.15766","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.15766","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T22:32:01Z","timestamp":1692570721000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jce.15766"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,12]]},"references-count":23,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,3]]}},"alternative-id":["10.1111\/jce.15766"],"URL":"https:\/\/doi.org\/10.1111\/jce.15766","archive":["Portico"],"relation":{},"ISSN":["1045-3873","1540-8167"],"issn-type":[{"value":"1045-3873","type":"print"},{"value":"1540-8167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,12]]},"assertion":[{"value":"2022-09-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-25","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}