Ablation Techniques in a Patient with a Right Accessory Pulmonary Vein. Is it Always Feasible?

A 32-year-old woman with lone paroxysmal atrial fibrillation had two pulmomary vein isolation procedures over 1 year, by means of the circular multipolar duty-cycled radiofrequency PVAC catheter in the first and the Thermocool® SmartTouchTM catheter in the second procedure. Following both procedures, the patient remained highly symptomatic on a weekly to monthly basis and a third procedure was performed by using the second generation of cryoballoon Arctic Front AdvanceTM. Right inferior pulmonary vein was completely reconnected and an extreme hockey stick configuration was necessary in order to achieve complete occlusion and isolation. Thirty months later the patient remains symptom free in the absence of any therapy. Rhythmos 2016;11(4):96-97