TY - JOUR T1 - Identification of a critical isthmus in complex macroreentrant atrial tachycardia using Ripple mapping in a patient with surgically repaired Ebstein's anomaly JO - Revista Portuguesa de Cardiologia T2 - AU - Lima da Silva,Gustavo AU - Cortez-Dias,Nuno AU - Carpinteiro,Luís AU - de Sousa,João SN - 08702551 M3 - 10.1016/j.repc.2017.08.009 DO - 10.1016/j.repc.2017.08.009 UR - https://revportcardiol.org/pt-identification-critical-isthmus-in-complex-articulo-S0870255117300203 AB - Ripple mapping is a novel, three-dimensional, electroanatomic mapping tool that displays each electrogram at its corresponding 3-dimensional coordinate as a dynamic moving bar, which changes in length according to the electrogram voltage-time relationship. We present the case of a 43-year-old male patient with surgically repaired Ebstein's anomaly who previously underwent two unsuccessful ablation procedures for right atrial flutter (cavotricuspid isthmus and intercaval lines). Ripple mapping was decisive, enabling the arrhythmia mechanism to be appropriately recognized, and a distinction to be made between critical areas of the circuit and delayed activated bystander regions. ER -