title: Atrial mapping during pulmonary vein pacing: a novel maneuver to detect and close residual conduction gaps in an ablation line.
abstract: BACKGROUND
  Location 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.
  
  
  RESULTS
  We 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.
  
  
  CONCLUSIONS
  The "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.
authors.affiliation: Electrophysiology Laboratory and Arrhythmia Unit, Hospital Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain. jeffersonsalas@gmail.com.
authors.forename: Jefferson
authors.initials: J
authors.lastname: Salas
authors.affiliation: Electrophysiology Laboratory and Arrhythmia Unit, Hospital Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Castellanos
authors.affiliation: Electrophysiology Laboratory and Arrhythmia Unit, Hospital Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Peinado
authors.affiliation: Electrophysiology Laboratory and Arrhythmia Unit, Hospital Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Madero
authors.affiliation: Electrophysiology Laboratory and Arrhythmia Unit, Hospital Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Barrio-López
authors.affiliation: Electrophysiology Laboratory and Arrhythmia Unit, Hospital Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Ortiz
authors.affiliation: Electrophysiology Laboratory and Arrhythmia Unit, Hospital Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Almendral
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods; D004553:Electric Conductivity; D005260:Female; D006325:Heart Atria; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: Ablation; Atrial fibrillation; Pace and map; Pulmonary veins