BackgroundLocation of residual conduction gaps on ablation lines around pulmonary veins (PV) is challenging, and several maneuvers have been described. Atrial mapping during PV pacing—the “pace and map” maneuver—could localize gaps.Methods and resultsWe prospectively studied 209 patients undergoing PV isolation at a single institution over a 25-month period. In 24 (11.4 %) patients, 26 PV remained connected after an ablation line and an initial conventional gap closure protocol. 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. Ablation at these gap sites resulted in bidirectional PV conduction block in 22 PV (85 %) in 21 patients (88 %), after 2.2 ± 1.6 radiofrequency applications and 8.2 ± 4.8 min. Early PV reconnection (≥20 min) occurred in 0 PV (0 %). During a mean follow-up of 12 ± 6 months, eight patients (33 %) had arrhythmia recurrences.ConclusionsThe “pace and map” maneuver is a relatively simple and efficacious means to identify gaps in ablation lines around PV, focusing on the atrial rather than the PV side of the line. It could be considered among the ways to eliminate residual conduction gaps.

Pacing thresholds correlate with CF in human not previously ablated LA. Since the combination of a normal bipolar voltage and a unipolar pacing threshold <2.85 mA provide reasonable parameters of validity, pacing threshold could be of interest as a surrogate for CF in LA.

P&M 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 P&M maneuver reduced the radiofrequency time required to isolate the PV without compromising the efficacy.

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