Atrial TachycardiaNCT03915691
The RIPPLE AT-PLUS Study
A study testing Catheter ablation of atrial tachycardia: Ripple Mapping guided. and Catheter ablation of atrial tachycardia: Conventional mapping guided. in people with Atrial Tachycardia, run by Liverpool Heart and Chest Hospital NHS Foundation Trust at 3 sites in United Kingdom.
Trial summary
Atrial tachycardia is a symptomatic arrhythmia, for which an effective treatment is a catheter ablation procedure. The goal of the Ripple AT-Plus study is to evaluate two methods of performing catheter ablation for atrial tachycardia. Read more about this study
- Who is it for?
- Ages 18 to 80 years
- Conditions the study is for
- Atrial Tachycardia
- What is being tested?
- Catheter ablation of atrial tachycardia: Ripple Mapping guided. and Catheter ablation of atrial tachycardia: Conventional mapping guided.
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 201 participants
- Where
- 3 sitesUnited Kingdom
- Study dates
- 16 Aug 2022to 3 Jun 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 80 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Referred for catheter ablation of AT by the direct care team, based on clinical indication.
- Male or female, aged >18 years old.
- Able to consent for recruitment to the trial and the catheter ablation procedure.
Who cannot join
- Contraindication to catheter ablation as deemed by the clinical team.
- Typical atrial flutter or AF on ECG.
Trial locations and contacts
3 sites in 1 country.
United Kingdom3 sites
Liverpool Heart & Chest Hospital
London, L14 3PE
Imperial College Healthcare NHS Trust
London, W12 0HS
Freeman Hospital, The Newcastle Upon Tyne NHS Foundation Trust
Newcastle, NE7 7DN
About this study
Official title: Isthmus Guided vs Anatomical Linear Ablation in the Treatment of Scar Related Atrial Tachycardia
Atrial tachycardia is a symptomatic arrhythmia, for which an effective treatment is a catheter ablation procedure. The goal of the Ripple AT-Plus study is to evaluate two methods of performing catheter ablation for atrial tachycardia. The main outcome assessed during the study is long-term recurrence of atrial tachycardia following the catheter ablation procedure.
Read the detailed description
Catheter based mapping of the electrical signals in the heart during atrial tachycardia can identify areas that require ablation in order to treat the arrhythmia. There are numerous methods by which to map atrial tachycardia. Isthmus guided ablation using Ripple Mapping is one such method, and has recently been demonstrated to improve diagnostic accuracy of mapping and therefore improve acute procedural outcomes (termination of the tachycardia).
However, it is not known if improved acute procedural outcomes translate into long-term benefits for patients. At present, the recurrence rate following atrial tachycardia ablation is near 30%. We hypothesise that isthmus guided ablation using Ripple Mapping can reduce long-term recurrence following ablation as improved diagnostic accuracy of mapping can lead to more targeted, less extensive, ablation.
Patients referred for catheter ablation of atrial tachycardia will be randomised to undergo the procedure by isthmus targeted approach using Ripple Mapping or conventional approach using local activation time. Otherwise, the catheters used to perform the mapping and ablation will be the same in both groups. After the procedure, follow up will occur at 1 year with a further Holter Montior. Any arrhythmia recurrence will be documented and the two arms will be compared for acute success, 12 month success, ablation required and procedure time.
- Conditions
- Atrial Tachycardia
- Being tested
- Catheter ablation of atrial tachycardia: Ripple Mapping guided., Catheter ablation of atrial tachycardia: Conventional mapping guided.
- Keywords
- Atrial Tachycardia, Atrial Fibrillation, Mapping, Ablation
- Medical subject headings
- Atrial Fibrillation
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Catheter ablation of atrial tachycardia: Ripple Mapping guided.Procedure or surgery
Ripple Mapping is used to map the atrial tachycardia mechanism. Using the scar thresholding technique the Ripple Map is interpreted and catheter ablation directed to the site of the heart identified as putative to the arrhythmia mechanism. All ablation lesions are confirmed to have conduction block across them using Ripple Mapping. This can include lesions created at previous ablation procedures.
Catheter ablation of atrial tachycardia: Conventional mapping guided.Procedure or surgery
Conventional activation mapping is used to map the atrial tachycardia mechanism. The resultant (activation) map is interpreted and ablation directed to the site of the heart identified as putative to the arrhythmia mechanism. All ablation lesions are confirmed to have conduction block across them using conventional mapping. This can include lesions created at previous ablation procedures.
| Study group | Role | What they receive |
|---|---|---|
| Isthmus targeted approach using Ripple Mapping | Active comparator | Intervention: Isthmus targeted approach using Ripple Mapping catheter ablation of atrial tachycardia. Receives: Procedure: Catheter ablation of atrial tachycardia: Ripple Mapping guided. |
| Conventional Mapping | Active comparator | Intervention: conventional catheter ablation of atrial tachycardia. Receives: Procedure: Catheter ablation of atrial tachycardia: Conventional mapping guided. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Atrial arrhythmia recurrence
Any confirmed episode of atrial arrhythmia (>30 seconds on Holter or 12 lead ECG) occurring in the 12 months after catheter ablation.
Measured: 12 months
Secondary outcomes (5)
Acute success during the catheter ablation procedure by the first ablation set.
Atrial tachycardia termination (acute success) during ablation delivered to only target the diagnosed AT mechanism by the mapping approach used (first ablation set).
Measured: Procedure.
Acute success during the catheter ablation procedure without the need of entrainment.
Entrainment not required to confirm or exclude the diagnosis made by 3D electroanatomic mapping methods.
Measured: Procedure.
Procedure failure.
Inability to terminate atrial tachycardia during the catheter ablation procedure, requiring external electrical cardioversion to achieve sinus rhythm.
Measured: Procedure.
Total procedure time.
Procedure time measured from initiation of intracardiac mapping to catheter removal from the body.
Measured: Procedure.
Ablation required
Ablation required, measured using pre-defined ablation index or ablation line length.
Measured: Procedure.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted16 Apr 2019
- Study start16 Aug 2022
- Primary completion3 Jun 2025
- Study completion3 Jun 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Atrial TachycardiaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 201 participants (actual)
Sponsor and investigators
- Lead sponsor
- Liverpool Heart and Chest Hospital NHS Foundation Trust
- Sponsor type
- University, hospital or other
- Collaborators
- Imperial College Healthcare NHS Trust, Norfolk and Norwich University Hospitals NHS Foundation Trust, Nottingham University Hospitals NHS Trust, University Hospital Plymouth NHS Trust, Blackpool Teaching Hospitals NHS Foundation Trust, Cardiff and Vale University Health Board, University Hospitals Sussex NHS Foundation Trust
- Responsible party
- Sponsor
- Investigators
- Vishal Luther, MBBS, Principal investigator, Liverpool Heart & Chest Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03915691
- Sponsor's protocol ID
- 19SM5013
- Status last verified
- Oct 2026
- First submitted
- 12 Apr 2019
- Last updated
- 19 Oct 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Kailey B, Kemp I, Taylor M, Crooks J, Katritsis G, Koa-Wing M, Jamil-Copley S, Linton N, Kanagaratnam P, Gupta D, Luther V. Ripple AT Plus - isthmus-guided vs conventional ablation in the treatment of scar-related atrial tachycardia: study protocol for a randomised controlled trial. J Interv Card Electrophysiol. 2023 Oct;66(7):1533-1539. doi: 10.1007/s10840-023-01607-8. Epub 2023 Aug 18.
PubMed 37594646
Study at a glance
From the registry record, last updated by the sponsor on 19 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Isthmus Guided vs Anatomical Linear Ablation in the Treatment of Scar Related Atrial Tachycardia
- ClinicalTrials.gov ID
- NCT03915691
- Acronym / sponsor ID
- 19SM5013
- Conditions
- Atrial Tachycardia
- Keywords
- Atrial Tachycardia, Atrial Fibrillation, Mapping, Ablation
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 201 participants (actual)
- Lead sponsor
- Liverpool Heart and Chest Hospital NHS Foundation TrustUniversity, hospital or other
- Collaborators
- Imperial College Healthcare NHS Trust, Norfolk and Norwich University Hospitals NHS Foundation Trust, Nottingham University Hospitals NHS Trust, University Hospital Plymouth NHS Trust, Blackpool Teaching Hospitals NHS Foundation Trust, Cardiff and Vale University Health Board, University Hospitals Sussex NHS Foundation Trust
- Study start
- 16 Aug 2022 (actual)
- Primary completion
- 3 Jun 2025 (actual)
- Study completion
- 3 Jun 2026 (actual)
- First posted
- 16 Apr 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Atrial tachycardia is a symptomatic arrhythmia, for which an effective treatment is a catheter ablation procedure. The goal of the Ripple AT-Plus study is to evaluate two methods of performing catheter ablation for atrial tachycardia. The main outcome assessed during the study is long-term recurrence of atrial tachycardia following the catheter ablation procedure.
Detailed description
Catheter based mapping of the electrical signals in the heart during atrial tachycardia can identify areas that require ablation in order to treat the arrhythmia. There are numerous methods by which to map atrial tachycardia. Isthmus guided ablation using Ripple Mapping is one such method, and has recently been demonstrated to improve diagnostic accuracy of mapping and therefore improve acute procedural outcomes (termination of the tachycardia).
However, it is not known if improved acute procedural outcomes translate into long-term benefits for patients. At present, the recurrence rate following atrial tachycardia ablation is near 30%. We hypothesise that isthmus guided ablation using Ripple Mapping can reduce long-term recurrence following ablation as improved diagnostic accuracy of mapping can lead to more targeted, less extensive, ablation.
Patients referred for catheter ablation of atrial tachycardia will be randomised to undergo the procedure by isthmus targeted approach using Ripple Mapping or conventional approach using local activation time. Otherwise, the catheters used to perform the mapping and ablation will be the same in both groups. After the procedure, follow up will occur at 1 year with a further Holter Montior. Any arrhythmia recurrence will be documented and the two arms will be compared for acute success, 12 month success, ablation required and procedure time.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Isthmus targeted approach using Ripple Mapping | Active comparator | Procedure: Catheter ablation of atrial tachycardia: Ripple Mapping guided.Intervention: Isthmus targeted approach using Ripple Mapping catheter ablation of atrial tachycardia. |
| Conventional Mapping | Active comparator | Procedure: Catheter ablation of atrial tachycardia: Conventional mapping guided.Intervention: conventional catheter ablation of atrial tachycardia. |
Who may qualify
- Ages
- 18 to 80 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Referred for catheter ablation of AT by the direct care team, based on clinical indication.
- Male or female, aged >18 years old.
- Able to consent for recruitment to the trial and the catheter ablation procedure.
Key exclusion criteria (2 listed)
- Contraindication to catheter ablation as deemed by the clinical team.
- Typical atrial flutter or AF on ECG.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Catheter ablation of atrial tachycardia: Ripple Mapping guided.Ripple Mapping is used to map the atrial tachycardia mechanism. Using the scar thresholding technique the Ripple Map is interpreted and catheter ablation directed to the site of the heart identified as putative to the arrhythmia mechanism. All ablation lesions are confirmed to have conduction block across them using Ripple Mapping. This can include lesions created at previous ablation procedures. | Procedure or surgery | Isthmus targeted approach using Ripple Mapping |
| Catheter ablation of atrial tachycardia: Conventional mapping guided.Conventional activation mapping is used to map the atrial tachycardia mechanism. The resultant (activation) map is interpreted and ablation directed to the site of the heart identified as putative to the arrhythmia mechanism. All ablation lesions are confirmed to have conduction block across them using conventional mapping. This can include lesions created at previous ablation procedures. | Procedure or surgery | Conventional Mapping |
Primary outcome
Atrial arrhythmia recurrence
Time frame: 12 months
Any confirmed episode of atrial arrhythmia (>30 seconds on Holter or 12 lead ECG) occurring in the 12 months after catheter ablation.
5 secondary outcomes
Acute success during the catheter ablation procedure by the first ablation set.
Time frame: Procedure.
Acute success during the catheter ablation procedure without the need of entrainment.
Time frame: Procedure.
Procedure failure.
Time frame: Procedure.
Total procedure time.
Time frame: Procedure.
Ablation required
Time frame: Procedure.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 19 Oct 2026.
- Derived from this study: PubMed 37594646Kailey B, Kemp I, Taylor M, Crooks J, Katritsis G, Koa-Wing M, Jamil-Copley S, Linton N, Kanagaratnam P, Gupta D, Luther V. Ripple AT Plus - isthmus-guided vs conventional ablation in the treatment of scar-related atrial tachycardia: study protocol for a randomised controlled trial. J Interv Card Electrophysiol. 2023 Oct;66(7):1533-1539. doi: 10.1007/s10840-023-01607-8. Epub 2023 Aug 18.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Vishal Luther, MBBS principal investigator
Liverpool Heart & Chest Hospital
3 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Catheter ablation of atrial tachycardia: Ripple Mapping guided. and Catheter ablation of atrial tachycardia: Conventional mapping guided. in people with Atrial Tachycardia, run by Liverpool Heart and Chest Hospital NHS Foundation Trust at 3 sites in United Kingdom.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 19 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 3 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Atrial arrhythmia recurrence (time frame: 12 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03915691, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Oct 2026.