Focal AF‐ablation after Pulmonary Vein Isolation in a Patient with Hypertrophic Cardiomyopathy Using Cryothermal Energy

A 42‐year‐old man, with a history of hypertrophic cardiomyopathy (HCM), an electrocardiogram pattern of ventricular preexcitation typical for mutations in the PRKAG2 gene, and highly symptomatic paroxysmal drug‐resistant atrial fibrillation (AF), underwent successful circumferential isolation of his pulmonary veins using a 28‐mm double lumen cryoballoon. Because AF was still inducible with programmed stimulation, fractionated signals were targeted in the left atrium with a conventional cryocatheter. Ablation of an endocardial focus with fractionated potentials at the base of the left appendage terminated the episode and rendered AF noninducible. No recurrence of AF was observed during a 10‐month follow‐up period.