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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.Prevention of phrenic nerve injury during interventional electrophysiologic procedures
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The advent of innovative, potent ablative technologies and the adoption of endo–epicardial approaches to treat various arrhythmias have engendered a need for developing strategies to prevent collateral damage to critical structures such as the phrenic nerve (PN) and the esophagus during percutaneous electrophysiologic interventions. Here we detail phrenic nerve injury (PNI) prevention strategies during atrial fibrillation (AF), atrial tachycardia (AT), and ventricular tachycardia (VT) ablation. PNI is more common on the right side because of the anatomic course of the nerve and the greater preponderance of AF and AT ablations.How to perform antral pulmonary venous isolation using the cryoballoon
This article describes our current practice, clinical outcomes, and future directions for the use of balloon cryoablation for the treatment of atrial fibrillation.How to perform and interpret rotational angiography in the electrophysiology laboratory
Sophisticated imaging methods have been growing in popularity since the introduction of curative ablation procedures for atrial fibrillation (AF). This trend is predicated on the need for a precise anatomic guidance within the complex left atrial (LA) anatomy and less reliance on electrocardiographic characteristics of the substrate. Traditional two-dimensional imaging methods such as fluoroscopy would not satisfy the needs of a complex catheter navigation inside three-dimensional (3D) anatomic structures that may not be confined to the radiographic cardiac silhouette (e.g., pulmonary veins [PVs]).
