Ripple Frequency Determined via a Novel Algorithm Is Associated With Atrial Fibrillation Termination and Freedom From Atrial Fibrillation

Daniel P. Melby, Venkatakrishna N. Tholakanahalli, Refael Itah, Raed Abdelhadi, Jay Sengupta, Charles C. Gornick, Jo Ellyn Moore, Manjunath Pai, David G. Benditt

Research output: Contribution to journalArticlepeer-review


Background: Persistent atrial fibrillation (AF) is a complex arrhythmia, and attaining freedom from AF with ablation has been challenging. Objectives: This study evaluated a novel CARTO software algorithm based on the CARTO Ripple map for AF termination and 18-month freedom from AF. Methods: Consecutive patients who underwent first-time ablation for persistent AF were included. A high-density Ripple map was created using a Pentaray catheter. Following PVI, ablation was performed at locations with rapid Ripple activations, a protocol previously described by us. Patients were followed for 18 months to assess rhythm outcomes. A retrospective analysis was performed using the CARTO Ripple frequency software algorithm. The Ripple frequency algorithm quantifies amplitude changes in the bipolar electrogram. Results: A total of 115 AF maps were analyzed from 84 patients (mean age 65.9 years, 63.1% men). The top quartile of Ripple frequency corresponded to a visual reference with 96.7% sensitivity and 91.1% specificity. AF terminated during ablation in 88.1% of patients: pulmonary vein antrum alone (14.9%) or pulmonary vein plus nonantral sites (85.1%). The top quartile of Ripple frequency was present in nonantral areas associated with AF termination with 90.2% sensitivity and 86.5% specificity. After 14.0 ± 6.5 months and 1.2 ± 0.4 ablations, 78 (92.9%) of 84 patients were free of AF, and 79.8% were free of any atrial arrhythmia. Conclusion: A novel algorithm for automated analysis of CARTO Ripple frequency demonstrated good sensitivity and specificity for detecting atrial regions in persistent AF in which ablation is associated with frequent AF termination and freedom from AF during follow-up.

Original languageEnglish (US)
Pages (from-to)665-672
Number of pages8
JournalHeart Rhythm O2
Issue number6Part A
StatePublished - Dec 2022

Bibliographical note

Funding Information:
The authors have no funding sources to disclose. Dr Melby receives honoraria from Biosense Webster for educational and board member activities. No other author has disclosures. All authors attest they meet the current ICMJE criteria for authorship. All patients consented to research participation. Institutional Review Board approval was obtained, and the research reported in this paper adhered to the Helsinki Declaration guidelines.

Publisher Copyright:
© 2022 Heart Rhythm Society


  • Ablation
  • Atrial fibrillation ablation
  • Electroanatomic map
  • Persistent atrial fibrillation
  • Ripple frequency
  • Ripple map

PubMed: MeSH publication types

  • Journal Article


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