Novel technique to avoid diaphragmatic paralysis during focal ablation of a non–pulmonary vein trigger mapped to the crista terminalis

Introduction Almost 90% of triggers for atrial fibrillation (AF) are believed to originate from the pulmonary veins, and pulmonary vein isolation is the mainstay of therapy for patients with paroxysmal AF. Patients who demonstrate recurrent AF despite pulmonary vein isolation highlight the challenge and need of identifying non–pulmonary vein triggers. Reproducibility and inherent risk of the location of these foci may limit the success.