Liverpool Heart & Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK.
Imperial College London, Imperial College Healthcare NHS Trust, London, UK.
J Interv Card Electrophysiol. 2023 Oct;66(7):1533-1539. doi: 10.1007/s10840-023-01607-8. Epub 2023 Aug 18.
Catheter ablation is routinely used to treat scar-related atrial tachycardia (s-AT). Conventional ablation often involves creating anatomical "lines" that transect myocardial tissue supporting reentry. This can be extensive, creating iatrogenic scar as a nidus for future reentry, and may account for arrhythmia recurrence. High-density mapping may identify "narrower isthmuses" requiring less ablation, with ripple mapping proven to be an effective approach in identifying. This trial explores whether ablation of narrower isthmuses in s-AT, defined using ripple mapping, results in greater freedom from arrhythmia recurrence compared to conventional ablation.
The Ripple-AT-Plus trial (registration ClinicalTrials.gov , NCT03915691) is a prospective, multicentre, single-blinded, randomised controlled trial with 12-month follow-up. Two hundred s-AT patients will be randomised in a 1:1 fashion to either "ripple mapping-guided isthmus ablation" vs conventional ablation on the CARTO3 ConfiDENSE system (Biosense Webster). The primary outcome will compare recurrence of any atrial arrhythmia. Multicentre data will be analysed over a secure web-based cloud-storage and analysis software (CARTONET).
This is the first trial that considers long-term patient outcomes post s-AT ablation, and whether targeting narrower isthmuses in the era of high density is optimal.
导管消融术通常用于治疗与瘢痕相关的房性心动过速（s-AT）。常规消融术通常涉及创建解剖“线”，以横断支持折返的心肌组织。这可能是广泛的，会产生医源性瘢痕作为未来折返的病灶，并可能导致心律失常复发。高密度标测可能会识别需要较少消融的“更窄的峡部”，而波纹标测已被证明是一种有效的识别方法。本试验探讨了使用波纹标测定义的 s-AT 中较窄峡部的消融是否比常规消融更能避免心律失常复发。
Ripple-AT-Plus 试验（注册ClinicalTrials.gov，NCT03915691）是一项前瞻性、多中心、单盲、随机对照试验，随访时间为 12 个月。200 例 s-AT 患者将以 1:1 的比例随机分为“波纹标测引导峡部消融”组与常规消融组，在 CARTO3 ConfiDENSE 系统（Biosense Webster）上进行消融。主要结局将比较任何房性心律失常的复发率。多中心数据将通过安全的基于网络的云存储和分析软件（CARTONET）进行分析。
这是第一项考虑 s-AT 消融后长期患者结局的试验，以及在高密度时代，是否靶向较窄的峡部是最佳选择。
