Perforation of the Left Atrial Appendage Caused by Inadvertent Deployment of a Soft J-Tipped Guidewire During Radiofrequency Hot-Balloon Ablation.

(Spring Guide Wire, Toray Industries, Tokyo, Japan) was advanced into the upper branch of the LSPV (Figure 1B) and energy was applied for 240 s at 70°C. Residual conduction of the LSPV was found at the anterior carina, and further energy application at the left inferior PV (LIPV) isolated the LSPV (“cross-talk” phenomenon; Figure 1C). Re-conduction of the LSPV was observed after the termination of energy delivery. Therefore, we advanced the A 78-year-old male patient with a history of highly symptomatic paroxysmal atrial fibrillation underwent pulmonary vein (PV) isolation (PVI) using a radiofrequency hot-balloon (RHB) catheter (SATAKE Hot-Balloon, Toray Industries, Tokyo, Japan).1 After simultaneous PV angiography (Figure 1A) and successful isolation of the right PV, isolation of the left superior PV (LSPV) was attempted. Initially, a soft J-tipped guidewire