Novel Ripple Frequency-Guided Substrate Targeting for Persistent Atrial Fibrillation: 12-Month Outcomes

BackgroundOutcomes after pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) remain limited, motivating patient-specific strategies to identify non-PV sources. Ripple Frequency is an automated mapping algorithm designed to localize AF sources for targeted ablation by highlighting regions with high frequency directional changes in electrogram dV/dT. ObjectiveTo evaluate 12-month freedom from AF and any atrial arrhythmia following non-PV Ripple Frequency-guided ablation for persistent AF. MethodsWe analyzed 72 patients undergoing first-time ablation for persistent AF. After PVI, ablation was directed at non-PV atrial regions in the top quartile of each patients Ripple Frequency maps. The primary endpoint was first AF recurrence >30 s after a 90-day blanking period on or off antiarrhythmic drugs (AADs); secondary endpoints included atrial tachycardia/flutter (AT/AFL), any atrial arrhythmia, and safety. Freedom from AF at 12 months was compared with that observed in the PVI arm of the STAR-AF II trial for additional context. ResultsRipple Frequency targets were ablated in 66/72 patients (92%), yielding acute AF termination in 64/72 patients (88.9%). Single procedure 12-month freedom from AF was 95.8% (95% CI 87.6-98.6) on/off AAD, and freedom from any atrial arrhythmia was 72.2% (95% CI 60.3-81.1). After 1.2 procedures, these rose to 97.2% and 90.3%. Compared with the STAR-AF II PVI arm (60%), 12-month AF freedom was 35.8% (95% CI 22.3-40.0%) higher. ConclusionIn this single-center cohort, non-PV ablation guided by Ripple Frequency was associated with a high 12-month AF and any arrhythmia freedom with no major complications. Central Illustration O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=109 SRC="FIGDIR/small/25336693v1_ufig1.gif" ALT="Figure 1"> View larger version (38K): org.highwire.dtl.DTLVardef@1a83597org.highwire.dtl.DTLVardef@5658a3org.highwire.dtl.DTLVardef@d547f8org.highwire.dtl.DTLVardef@67fb9f_HPS_FORMAT_FIGEXP M_FIG C_FIG