Abstract
A 60-year-old man with obesity and severe left ventricular dysfunction and left atrial dilatation underwent catheter ablation of symptomatic, drug-refractory, persistent atrial fibrillation. After pulmonary vein isolation and electrogram-based ablation, atrial fibrillation was cardioverted successfully. Mitral isthmus ablation was undertaken during distal coronary sinus (CS) 1 to 2 pacing. CS blood flow was occluded by inflating a 1-cm spherical balloon distally. During ongoing radiofrequency application using an irrigated ablation catheter (average power, 34 W; temperature, 39°C) on the endocardial mitral isthmus line, conduction delay between the bipoles CS 1 to 2 (pacing site) …
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