title: Pulmonary vein isolation in cases of difficult catheter placement: a new pacing maneuver to demonstrate complete isolation of the veins.
abstract: BACKGROUND
  Pulmonary vein electrical isolation is the main goal of atrial fibrillation ablation. To ensure electrical isolation of the pulmonary veins, entrance and exit block should be demonstrated. However, this is sometimes challenging due to the complex anatomy of the pulmonary vein area and the anatomical variations that may preclude the correct position of the commonly used circular multielectrode catheter inside the veins.
  
  
  OBJECTIVE
  To describe a new pacing maneuver useful to demonstrate complete isolation of ipsilateral veins in cases of difficult catheter placement.
  
  
  METHODS
  Three representative cases illustrate the usefulness of the maneuver either at the right or left pulmonary veins.
  
  
  RESULTS
  After the circumferential ablation of ipsilateral veins, the circular catheter is positioned in one vein and the ablation catheter in the other ipsilateral vein. When local capture in one vein can be demonstrated while pacing from the other vein and no conduction to the atria is observed, isolation of both veins can be assured.
  
  
  CONCLUSIONS
  This novel maneuver might be of help in assessing complete isolation of the pulmonary veins in cases of difficult circular catheter placement.
authors.affiliation: Arrhythmia Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. calonso@santpau.cat
authors.forename: Concepción
authors.initials: C
authors.lastname: Alonso-Martín
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodríguez Font
authors.forename: Jose M
authors.initials: JM
authors.lastname: Guerra
authors.forename: Xavier
authors.initials: X
authors.lastname: Viñolas Prat
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000601:surgery*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D002404:Catheterization / Q000379:methods*; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*
keywords: AF; Ablation; Atrial fibrillation; LA; MRI; PV; Pulmonary veins; RIPV; RSPV; atrial fibrillation; left atrial/atrium; magnetic resonance imaging; pulmonary vein; right inferior pulmonary vein; right superior pulmonary vein