Arrhythmias & electrophysiologyResearch article
Ripple mapping demonstrates putative signals identifying the right inferior nodal extension to the lower nodal bundle during atrioventricular nodal reentrant tachycardia (AVNRT)
- Electrophysiological mapping study
Authors' conclusion
Ripple mapping can delineate slow and fast pathway activation during AVNRT. Lower nodal bundle signals "lead" during AVNRT, inferior to the conventional His cloud. Ripple mapping-guided AVNRT ablation may be feasible.
Study context
- Population
- 72 patients undergoing electrophysiological studies, with typical AVNRT in 40 patientstypical AVNRT in 40 patients, full mapping protocol in 30 patients · typical AVNRT 40 · full mapping protocol 30
- Participants
- 72 patients
Main finding
As reported in the abstract
Points collected
Points collected
6327 ± 948
Further findings
| Outcome | Successful ablation sites | Unsuccessful sites | P value |
|---|---|---|---|
| Distance of ablation sites to E-AVNRT · closer to E-AVNRT with successful sites | 6.4 ± 3.0 (95% CI 5.2–7.6) mm | 14.8 ± 5.6 (95% CI 12.2–17.4) mm | P < 0.01 |
Distance of E-AVNRT inferior to earliest His during atrial pacing
- E-AVNRT inferior to earliest His
- 14.7 ± 5.3 mm
Slow pathway wavefront time from E-AVNRT to His cloud
- Time to reach His cloud
- 22.2 ± 4.8 ms
Earliest retrograde fast pathway-mediated right atrial activation during AVNRT relative to E-AVNRT
- Later than E-AVNRT
- 57.3 ± 27.1 ms
- Distance from E-AVNRT
- 11.7 ± 6.0 mm
- Distance from earliest atrial activation during ventricular pacing
- 7.0 ± 3.2 mm
Original publication
Ripple mapping demonstrates putative signals identifying the right inferior nodal extension to the lower nodal bundle during AVNRT. Heart Rhythm. Published 19 January 2026. doi:10.1016/j.hrthm.2025.12.042
Summarised from the published abstract; every number is checked against it