1. Volume 12, Issue 7, Pages 1658-1666 (July 2015)
Best practice guide for cryoballoon ablation in atrial fibrillation: The compilation experience of more than 3000 procedures 
Wilber Su, MD, FHRS, Robert Kowal, MD, FHRS, Marcin Kowalski, MD, FHRS, Andreas Metzner, MD, FHRS, J. Thomas Svinarich, MD, FHRS, Kevin Wheelan, MD, FHRS, Paul Wang, MD, FHRS 
Heart Rhythm 
Volume 12, Issue 7, Pages (July 2015)
DOI: /j.hrthm
Copyright © 2015 Heart Rhythm Society Terms and Conditions

2. Figure 1
Right anterior oblique (RAO) view of right inferior pulmonary vein cryoballoon engagement angle when transseptal site is lower and more anterior. Example of patient with atrial septal occlusion device at the secundum defect location better demonstrates the transseptal location.
Heart Rhythm  , DOI: ( /j.hrthm )
Copyright © 2015 Heart Rhythm Society Terms and Conditions

3. Figure 2
A: Intracardiac echocardiography (ICE) demonstrating lower and more anterior transseptal access (arrow). LA = left atrium; MV= mitral valve; RA = right atrium. Shown is transseptal sheath through the inferior septum location with thicker inferior limbus as well as anterior position with MV seen on ICE. B: Anatomic layout of optimal transseptal site (white oval). (Image modified courtesy of Visible Heart Lab, University of Minnesota. See Online Supplementary video.)
Heart Rhythm  , DOI: ( /j.hrthm )
Copyright © 2015 Heart Rhythm Society Terms and Conditions

4. Figure 3
Proximal seal technique. Instead of initiating ablation after initial venogram, CB is first gently pulled back to reveal the real pulmonary vein (PV) ostium by noting contrast leak. The true antrum is much further back than initially realized. CB at left superior PV (A) and venogram (B) showing CB pulled back to reveal the real PV ostium (see Online Supplementary video).
Heart Rhythm  , DOI: ( /j.hrthm )
Copyright © 2015 Heart Rhythm Society Terms and Conditions

5. Figure 4
Intracardiac ultrasound image of CB at left inferior pulmonary vein (PV) and color Doppler revealing flow from left superior PV. CB outside of the PV antrum forms the “golf ball on tee” image (see Online Supplementary video).
Heart Rhythm  , DOI: ( /j.hrthm )
Copyright © 2015 Heart Rhythm Society Terms and Conditions

6. Figure 5
Recordings of the diaphragmatic compound motor action potential (CMAP) during pacing from the coronary sinus (CS) catheter at 60 bpm located in the superior vena cava and during application of cryoenergy to the right superior pulmonary vein. CMAP amplitude (asterisk) significantly decreased at 180 seconds of cryoballoon application. Note that the pulmonary vein is isolated. At the time of phrenic nerve palsy, CMAP amplitude is a fraction of baseline CMAP amplitude. CMAP amplitude increased after cryoenergy was discontinued but did not return to its original value. A decrease in CMAP amplitude by 35% from baseline predicted and prevented phrenic nerve injury. (Reproduced from Lakhani M, Saiful F, Parikh V, Goyal N, Bekheit S, Kowalski M. Recordings of diaphragmatic electromyograms during cryoballoon ablation for atrial fibrillation accurately predict phrenic nerve injury. Heart Rhythm 2014;11:369–374.)
Heart Rhythm  , DOI: ( /j.hrthm )
Copyright © 2015 Heart Rhythm Society Terms and Conditions