Atrial mapping during pulmonary vein pacing to detect conduction gaps in a second pulmonary vein isolation procedure

Autor: Sergio Madero, Jesús Almendral, Eduardo Castellanos, Carla Lázaro, María Teresa Barrio-López, Mercedes Ortiz, Jefferson Salas, Martín Arceluz
Rok vydání: 2018
Předmět:
Zdroj: Journal of Interventional Cardiac Electrophysiology. 53:195-205
ISSN: 1572-8595
1383-875X
DOI: 10.1007/s10840-018-0371-x
Popis: Finding the conduction gaps in redo PV isolation procedures is challenging, and several maneuvers have been described. In the present study, we analyze the pace and map (PM) maneuver [atrial mapping during pulmonary vein (PV) pacing] to locate the gaps in redo PV isolation procedures.Consecutive patients undergoing a second PV isolation procedure at a single institution over a 4-year period were included. For the last 2 years, all the patients (n = 38) studied underwent PV isolation based on the PM maneuver and were compared to the previous patients (n = 45). The atrial side of the ablation line was mapped with the ablation catheter during PV pacing, and the earliest site was considered a gap site.Shorter radiofrequency time was required to obtain PV isolation in the PM group (485 ± 374 vs. 864 ± 544 s; p 0.001), which remained significant after adjusting for the number of reconnected PVs (p = 0.01). We did not find significant differences in the procedure duration (106 ± 46 vs. 112 ± 53 min; p = 0.57) and arrhythmia recurrence during 1-year follow-up (26.6 vs. 28.9%; p = 0.82) after adjusting for several confounding factors (HR 1.32; 95% CI 0.5-3.4; p = 0.57).PM is a simple maneuver to identify the gaps in ablation lines around the PV. It remains efficacious in redo procedures despite the difficulties in localizing the ablation lines performed in the first procedure. The PM maneuver reduced the radiofrequency time required to isolate the PV without compromising the efficacy.
Databáze: OpenAIRE
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