Maria Teresa Barrio-López1,2, Eduardo Castellanos3, Mercedes Ortiz3, Martín Arceluz3, Carla Lázaro3, Jefferson Salas3, Sergio Madero3, Jesús Almendral3. 1. Electrophysiology Laboratory and Arrhythmia Unit, Hospital Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain. terebarriol@gmail.com. 2. Unidad de Electrofisiología, Hospital Madrid Montepríncipe, Avda Monteprincipe, 25 28660 Boadilla del Monte, Madrid, Spain. terebarriol@gmail.com. 3. Electrophysiology Laboratory and Arrhythmia Unit, Hospital Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain.
Abstract
BACKGROUND: 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 (P&M) maneuver [atrial mapping during pulmonary vein (PV) pacing] to locate the gaps in redo PV isolation procedures. METHODS: 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 P&M 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. RESULTS: Shorter radiofrequency time was required to obtain PV isolation in the P&M 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). CONCLUSIONS: 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.
BACKGROUND: 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 (P&M) maneuver [atrial mapping during pulmonary vein (PV) pacing] to locate the gaps in redo PV isolation procedures. METHODS: 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 P&M 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. RESULTS: Shorter radiofrequency time was required to obtain PV isolation in the P&M 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). CONCLUSIONS: 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.
Authors: Hugh Calkins; Karl Heinz Kuck; Riccardo Cappato; Josep Brugada; A John Camm; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; John DiMarco; James Edgerton; Kenneth Ellenbogen; Michael D Ezekowitz; David E Haines; Michel Haissaguerre; Gerhard Hindricks; Yoshito Iesaka; Warren Jackman; Jose Jalife; Pierre Jais; Jonathan Kalman; David Keane; Young-Hoon Kim; Paulus Kirchhof; George Klein; Hans Kottkamp; Koichiro Kumagai; Bruce D Lindsay; Moussa Mansour; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Douglas L Packer; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Vivek Reddy; Jeremy N Ruskin; Richard J Shemin; Hsuan-Ming Tsao; David Wilber Journal: J Interv Card Electrophysiol Date: 2012-03 Impact factor: 1.900
Authors: Timir S Baman; Krit Jongnarangsin; Aman Chugh; Arisara Suwanagool; Aurelie Guiot; Arin Madenci; Spencer Walsh; Karl J Ilg; Sanjaya K Gupta; Rakesh Latchamsetty; Suveer Bagwe; James D Myles; Thomas Crawford; Eric Good; Frank Bogun; Frank Pelosi; Fred Morady; Hakan Oral Journal: J Cardiovasc Electrophysiol Date: 2011-01-15
Authors: Milena Leo; Michala F Pedersen; Kim Rajappan; Matthew Ginks; Yaver Bashir; Timothy R Betts Journal: Europace Date: 2017-06-01 Impact factor: 5.214