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

Abstract

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.

Localization of Residual Conduction Gaps After Wide Antral Circumferential Ablation of Pulmonary Veins

“…This technique was described in a cohort of patients benefiting from a first RF ablation of AF, when complete PVI was not obtained after a first pass, [34] and also in a group of patients undergoing a second PVI procedure. [40] One of the advantages described by the authors to support this technique is that the conduction in the atrium is expected to be less complex than in the PV antrum itself, resulting in less abnormal local EGMs, easier to annotate, compared to a PV mapping during atrial pacing. To note, this technique cannot be performed in case of unidirectional exit block, although such situation is uncommon, and is only feasible if PV remains excitable.…”