LAUSR

Ablation from both the anterior aspect of the right Introduction Pulmonary vein (PV) isolation has become the mainstay of atrial fibrillation (AF) ablation. Isolation of the right PV pair using an extraostial antral ablation approach is sometimes limited by the thickness of the atrial tissue along the anterior aspect of the vein pair. We describe a case of AF ablation where acute isolation of the right PV pair was not achieved with endocardial left atrial ablation alone, but required additional ablation from the adjacent right atrial septum. pulmonary veins in the left atrium and the corresponding right atrial aspect of the septummay be necessary to achieve transmural lesions and pulmonary vein isolation. Case report A 70-year-old woman with a history of symptomatic paroxysmal AF refractory to medical therapy with flecainide and dronedarone was referred for catheter ablation. Her medical history was only notable for hypothyroidism, breast cancer with prior radiation therapy, and prior spinal surgeries. The left ventricular systolic function was normal. The procedure was performed with uninterrupted anticoagulation with Xarelto. An octapolar catheter was placed in the coronary sinus, and dual transseptal access was achieved with intracardiac echocardiographic (ICE) and fluoroscopic guidance. After esophageal deviation with a dedicated esophageal retracting balloon (DV8 Balloon, Manual Surgical Sciences Inc, Minneapolis, MN), the left atrial anatomy was rendered using a multispline catheter and an electroanatomic mapping system (PentaRay, CARTO3; Biosense Webster Inc, Diamond Bar, CA). Using a deflectable sheath (Agilis, St. Jude, St. Paul, MN), ablation lesions were placed with a force-sensing irrigated ablation catheter (ThermoCool SmartTouch SurroundFlow, Biosense Webster Inc). The Visitag software module was used with ablation tags of 2 mm and a minimum force-time integral of 550 gs.