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A 56-year-old normotensive man presented for his second percutaneous atrial fibrillation (AF) ablation procedure. His arrhythmia was treated surgically in 2006 (epicardial radiofrequency pulmonary vein isolation and left atrial (LA) appendage resection), and then percutaneously in 2011 (endocardial re-isolation of pulmonary veins, with linear roof lesion). Despite this, it relapsed, and was associated with limiting dyspnoea.
Very high LA pressures were recorded during trans-septal puncture (figure 1), initially raising doubts about the exact location of the needle tip. However, the same results …