Atrial mapping during pulmonary vein pacing to detect conduction gaps in a second pulmonary vein isolation procedure

  • Maria Teresa Barrio-LópezEmail author
  • Eduardo Castellanos
  • Mercedes Ortiz
  • Martín Arceluz
  • Carla Lázaro
  • Jefferson Salas
  • Sergio Madero
  • Jesús Almendral



Finding the conduction gaps in redo PV isolation procedures is challenging, and several maneuvers have been described. In the present study, we analyze the pace and map (P&M) maneuver [atrial mapping during pulmonary vein (PV) pacing] to locate the gaps in redo PV isolation procedures.


Consecutive patients undergoing a second PV isolation procedure at a single institution over a 4-year period were included. For the last 2 years, all the patients (n = 38) studied underwent PV isolation based on the P&M maneuver and were compared to the previous patients (n = 45). 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.


Shorter radiofrequency time was required to obtain PV isolation in the P&M group (485 ± 374 vs. 864 ± 544 s; p < 0.001), which remained significant after adjusting for the number of reconnected PVs (p = 0.01). We did not find significant differences in the procedure duration (106 ± 46 vs. 112 ± 53 min; p = 0.57) and arrhythmia recurrence during 1-year follow-up (26.6 vs. 28.9%; p = 0.82) after adjusting for several confounding factors (HR 1.32; 95% CI 0.5–3.4; p = 0.57).


P&M is a simple maneuver to identify the gaps in ablation lines around the PV. It remains efficacious in redo procedures despite the difficulties in localizing the ablation lines performed in the first procedure. The P&M maneuver reduced the radiofrequency time required to isolate the PV without compromising the efficacy.


Atrial fibrillation Pulmonary vein isolation Mapping Conduction gaps Redo 



We acknowledge the cooperation of Rosa Crespo, Cristina Junco, Eva Lizana, Claudia Martín, and Miguel Hernández who helped in performing the procedures.

Compliance with ethical standards

Conflict of interest

J. Almendral has received honoraria for lectures from Abbott and Boston Scientific.

Ethical approval

This study was approved by the Hospital Ethics Committee.

Informed consent

Informed consent was obtained from all individual participants included in this study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Maria Teresa Barrio-López
    • 1
    • 2
    Email author
  • Eduardo Castellanos
    • 1
  • Mercedes Ortiz
    • 1
  • Martín Arceluz
    • 1
  • Carla Lázaro
    • 1
  • Jefferson Salas
    • 1
  • Sergio Madero
    • 1
  • Jesús Almendral
    • 1
  1. 1.Electrophysiology Laboratory and Arrhythmia Unit, Hospital Monteprincipe, Grupo HM HospitalesUniversity CEU-San PabloMadridSpain
  2. 2.Unidad de ElectrofisiologíaHospital Madrid MontepríncipeMadridSpain

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