Hands On
Pulmonary vein signal interpretation during cryoballoon ablation for atrial fibrillation
The recognition that paroxysmal atrial fibrillation (AF) is predominantly triggered by ectopic beats arising from the vicinity of pulmonary veins (PVs) has spurred the establishment of percutaneous procedures specifically designed to electrically sequestrate the arrhythmogenic PV from the vulnerable left atrium (LA) substrate.1 Recently, the procedure has evolved with the development of purpose-built pulmonary vein isolation (PVI) tools, such as the cryoballoon catheter. This article discusses the anatomic and electrophysiologic bases for the interpretation of pulmonary vein potentials (PVPs) using a small-caliber circular mapping catheter (CMC) and provides an expanded discussion on the pacing maneuvers relevant to cryoballoon-based PVI procedures.Catheter ablation in transposition of the great arteries with Mustard or Senning baffles
Complete transposition of the great arteries (D-TGA) accounts for 5% to 7% of congenital heart defects. Although the arterial switch procedure has now replaced atrial redirection as the surgical procedure of choice, most adults today with D-TGA have had Mustard or Senning baffles. These surgeries involve extensive atrial reconstruction and predispose to sinus node dysfunction and atrial tachyarrhythmias.1,2 By 20 years after surgery, the prevalence of atrial tachyarrhythmias is approximately 25%, continues to increase with time, and is similar among patients with Mustard or Senning baffles.
