# Catheter Ablation of Atrial Fibrillation in a Patient With a Left Atrial Band Using Intracardiac Echocardiography (ICE)‑Guided 3D Geometry and a Visualizable Sheath: A Case Report

## TL;DR

This case report describes a successful catheter ablation procedure for atrial fibrillation in a patient with a rare left atrial band, using advanced imaging techniques to guide the procedure safely.

## Contribution

The paper introduces a novel approach using intracardiac echocardiography and a visualizable sheath to safely perform ablation in the presence of a left atrial band.

## Key findings

- Intracardiac echocardiography (ICE) and a visualizable sheath enabled safe catheter ablation in a patient with a left atrial band.
- Post-procedural ICE confirmed the structural integrity of the left atrial band.
- The case highlights the importance of recognizing rare anatomical anomalies in arrhythmia treatment.

## Abstract

The left atrial band is a rare congenital structural anomaly in clinical practice. Its clinical significance in supraventricular arrhythmia and safe therapeutic strategies remains unclear. In this report, we present the case of a 68-year-old man with a history of myocardial infarction caused by thromboembolism secondary to atrial fibrillation who was admitted to our hospital for catheter ablation. Preprocedural contrast-enhanced CT revealed a cord-like structure, less than 2 mm in diameter, extending from the fossa ovalis to the left atrial roof. Catheter ablation was performed using the CARTO system with intracardiac echocardiography (CARTO SOUND) to create 3D geometry and visualize the sheath manipulation using a visualizable steerable sheath (VIZIGO) to confirm the spatial relationship between the steerable sheath and the left atrial band during manipulation of the ablation catheter. Post-procedural intracardiac echocardiography confirmed the integrity of the left atrial band. In conclusion, this case demonstrates that recognition of a left atrial band and the use of intracardiac echocardiography‑guided visualization with a visualizable sheath may assist in safe ablation procedures.