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Pulmonary vein–related maneuvers: Part I

  • Samuel J. Asirvatham
    Correspondence
    Address reprint requests and correspondence: Dr. Samuel J. Asirvatham, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905.
    Affiliations
    Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
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Published:January 15, 2007DOI:https://doi.org/10.1016/j.hrthm.2007.01.010
      With the rapid evolution of atrial fibrillation ablation procedures, electrophysiologists have necessarily strived for simple and anatomic-based approaches. In all except the most straightforward procedures, however, questions regarding the significance of various potentials recorded on mapping and ablation catheters arise.
      • Haissaguerre M.
      • Shah D.C.
      • Jais P.
      • Hocini M.
      • Yamane T.
      • Deisenhofer I.
      • Garrigue S.
      • Clementy J.
      Mapping-guided ablation of pulmonary veins to cure atrial fibrillation.
      • Pappone C.
      • Rosanio S.
      • Oreto G.
      • Tocchi M.
      • Gugliotta F.
      • Vicedomini G.
      • Salvati A.
      • Dicandia C.
      • Mazone P.
      • Santinelli V.
      • Gulletta S.
      • Chierchia S.
      Circumferential radiofrequency ablation of pulmonary vein ostia: a new anatomic approach for curing atrial fibrillation.
      Other articles in this series have described in detail the various approaches to atrial fibrillation ablation. In this article, the anatomic and electrophysiologic bases for pacing maneuvers used with a variety of ablation approaches are reviewed. The primary focus is on understanding the pacing maneuvers relevant to pulmonary vein (PV) isolation. These techniques, with some changes, can be applied to ablation of the superior vena cava and vein of Marshall.

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      References

        • Haissaguerre M.
        • Shah D.C.
        • Jais P.
        • Hocini M.
        • Yamane T.
        • Deisenhofer I.
        • Garrigue S.
        • Clementy J.
        Mapping-guided ablation of pulmonary veins to cure atrial fibrillation.
        Am J Cardiol. 2000; 86: K9-K19
        • Pappone C.
        • Rosanio S.
        • Oreto G.
        • Tocchi M.
        • Gugliotta F.
        • Vicedomini G.
        • Salvati A.
        • Dicandia C.
        • Mazone P.
        • Santinelli V.
        • Gulletta S.
        • Chierchia S.
        Circumferential radiofrequency ablation of pulmonary vein ostia: a new anatomic approach for curing atrial fibrillation.
        Circulation. 2000; 102: 2619-2628
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        • Asirvatham S.
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        Progress in nonpharmacologic therapy of atrial fibrillation.
        J Cardiovasc Electrophysiol. 2003; 14: S296-S309
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        Heart Rhythm. 2005; 2: 1090-1093