The image shows a left-sided thoracoscopic view of the oblique sinus during a hybrid atrial fibrillation ablation (procedure combining an endocardial and epicardial approach), which was performed after two failed endocardial radiofrequency pulmonary vein isolations (PVIs). The posterior left atrium is lifted using two surgical devices. The red spot areas are bleedings due to handling by the surgeon, which is commonly seen, already by gentle handling.
Fibrotic strands are visible at the antrum of the right inferior PV (white arrows) and on the opposite posterior pericardium (black arrows) overlying the oesophagus.
The fibrosis on the posterior pericardium is the result of collateral damage that occurred during previous PVI procedures. More extensive collateral damage could have resulted in oesophageal injury.
