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Stiff left atrial syndrome following left atrial appendage resection and multiple ablations for atrial fibrillation
  1. Geoffrey C Clare1,
  2. Andrei D Margulescu2,
  3. Fong T Leong1
  1. 1Cardiac Arrhythmia Service, University Hospital of Wales, Cardiff, UK
  2. 2Department of Cardiology, University and Emergency Hospital of Bucharest; University of Medicine and Pharmacy ‘Carol Davila’, Bucharest, Romania
  1. Correspondence to Dr Fong T Leong, Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK; f.t.leong{at}gmx.com

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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 …

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