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Atrial mapping during pulmonary vein pacing to detect conduction gaps in a second pulmonary vein isolation procedure.
- Source :
-
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2018 Nov; Vol. 53 (2), pp. 195-205. Date of Electronic Publication: 2018 May 25. - Publication Year :
- 2018
-
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.<br />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.<br />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).<br />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.
- Subjects :
- Aged
Atrial Fibrillation diagnostic imaging
Cardiac Pacing, Artificial methods
Electrocardiography methods
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Pulmonary Veins diagnostic imaging
Recurrence
Reoperation methods
Retrospective Studies
Risk Assessment
Treatment Outcome
Atrial Fibrillation surgery
Body Surface Potential Mapping methods
Catheter Ablation methods
Imaging, Three-Dimensional
Pulmonary Veins surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1572-8595
- Volume :
- 53
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
- Publication Type :
- Academic Journal
- Accession number :
- 29802499
- Full Text :
- https://doi.org/10.1007/s10840-018-0371-x