Percutaneous catheter ablation of atrial fibrillation in a patient with an anomalous pulmonary venous connection

A 62-year-old patient was referred for the treatment of highly symptomatic and drug-resistant paroxysmal atrial fibrillation (AF). First AF paroxysm occurred as early as 1992. At that time, patient was diagnosed with a partial anomalous pulmonary venous connection (PAPVC) without atrial septal defect (ASD). Now repetitive Holter monitoring revealed paroxysms of sustained AF. Transthoracic echocardiogram showed a right ventricular end-diastolic diameter of 44 mm, a systolic pulmonary arterial pressure of 52 mmHg, and a shunt ratio of 2.13. Left atrial (LA) diameter (PS-LAX) was 41 mm. Right atrium (RA) was dilated with a surface area of 24 cm2. Surgical repair of the anomalous pulmonary veins (PVs) …