PMC6342332_01
A: Anteroposterior fluoroscopy view showing total occlusion of the right inferior pulmonary vein (RIPV) during selective angiography. B: Electrocardiogram and electrogram of the RIPV (A1-2 to A7-8) and the coronary sinus (SC 1-2, SC 3-4) showing atrioventricular (AV) block during manipulation of the 28 mm cryoballoon catheter as shown in panel A. C: Computed tomography scan reconstruction showing a short distance between the RIPV ostium and aortic annulus at proximity of the AV node region.
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Preablation computed tomography (CT) scan showed normal pulmonary vein distribution (Figure 1A) and electrocardiography showed complete right bundle branch block. A pull-back maneuver allowed to obtain a total occlusion (Figure 1A). During this manipulation, and before cryoablation, a complete AV block occurred with an escape rhythm of 40 beats per minute with pre-existing right bundle branch block (Figure 1B, top).