Modified hockey stick maneuver utilizing a steerable cryoballoon catheter for left inferior pulmonary vein isolation

Successful cryoballoon pulmonary vein (PV) isolation sometimes requires cryoballoon occlusion techniques including a hockey stick maneuver (HSM) using a steerable sheath, whose steerable segment should be positioned in the left atrium (LA) for left inferior PV (LIPV) occlusion. However, a small LA can cause a transseptal puncture site adjacent to both the LIPV ostium and the LA roof, leading to the steerable segment out of the LA during the HSM. This report illustrates a modified HSM utilizing a steerable cryoballoon catheter, which might be considered as an option when the standard one is not operated as the LIPV occlusion technique.