Arrhythmia Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Heart Rhythm. 2013 Sep;10(9):1289-92. doi: 10.1016/j.hrthm.2013.04.025. Epub 2013 Apr 24.
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.
To describe a new pacing maneuver useful to demonstrate complete isolation of ipsilateral veins in cases of difficult catheter placement.
Three representative cases illustrate the usefulness of the maneuver either at the right or left pulmonary veins.
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.
This novel maneuver might be of help in assessing complete isolation of the pulmonary veins in cases of difficult circular catheter placement.
肺静脉电隔离是房颤消融的主要目标。为了确保肺静脉的电隔离，应显示入口和出口阻滞。然而，由于肺静脉区域的复杂解剖结构以及可能导致常用的圆形多电极导管在静脉内位置不正确的解剖变异，这有时具有挑战性。
描述一种新的起搏操作，该操作在导管放置困难时有助于证明同侧静脉的完全隔离。
三个有代表性的病例说明了该操作在右或左肺静脉中的有用性。
在同侧静脉的环形消融后，将圆形导管置于一条静脉中，将消融导管置于另一条同侧静脉中。当可以从另一条静脉起搏时证明一条静脉内的局部捕获，并且观察到没有传导到心房时，可以确保两条静脉的隔离。
在圆形导管放置困难的情况下，这种新的操作可能有助于评估肺静脉的完全隔离。
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