A 71-year-old male patient had symptomatic paroxysmal atrial fibrillation. Computed tomography detected that coronary arteriovenous fistula originated from the coronary left circumflex artery to the coronary sinus, which extended superiorly and traversed between the left superior pulmonary vein (LSPV) and the left atrial appendage (LAA). This fistula could be injured by catheter ablation to the LSPV. Hence, we performed extensive encircling pulmonary veins isolation on the right side and individual isolation for the left inferior pulmonary vein only but did not try our hands on the LSPV. There was no recurrence of atrial fibrillation with carvedilol over 10 months. Prior understanding of anatomical feature is warranted.1
Conflict of interest: none declared.
