LAUSR

If the LPN is located in the vicinity of the LAA ostium, segmental LAA electrical isolation is feasible and safe. Introduction The initiation of atrial fibrillation (AF) is triggered by focal circuits localized in the pulmonary veins (PVs) and sometimes outside the PVs. The left atrial appendage (LAA) plays a considerable role in the arrhythmogenesis of persistent and long-standing persistent AF (LSPAF), and its isolation confers significant clinical benefits, as evidenced by a series of studies. However, the anatomical proximity to the left phrenic nerve (LPN) might induce the electrophysiologists to refrain from isolating the LAA using standard technique at the ostial level. Herein, we describe a successful case of recurrent paroxysmal AF in which the LPN was localized at the LAA ostial level and compartmental electrical isolation of the LAA using radiofrequency ablation (RFA) was performed sparing the LPN thanks to identification of the anatomical path with pacemapping.