Abstract
A 63-year-old man with idiopathic dilated cardiomyopathy and highly symptomatic, drug-refractory paroxysmal atrial fibrillation was referred for catheter ablation. An extraostial pulmonary vein isolation procedure was performed under general anesthesia guided by electroanatomic mapping (EnSite System, St. Jude Medical Corp, St. Paul, MN), intracardiac echocardiography (UltraICE, Boston Scientific Corp, Natick, MA), and fluoroscopic guidance. Access to the left atrium was gained sequentially with 2 transseptal punctures and 9F LAMP sheaths (St. Jude Medical). Before transseptal crossing, the patient underwent anticoagulation with unfractionated heparin, and additional heparin was given to maintain an activated clotting time of 300 to 400 seconds. Ablation was performed with a 7F Chilli II ablation catheter (Boston Scientific) using temperature feedback power control (temperature=42°C, maximum power=35 W). While the anterior right pulmonary vein extraostial line was being created, the intracardiac echocardiography image identified a 4×5-mm echogenic mass adherent …
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