Perforation of multipolar electroanatomic mapping catheter in the left atrial appendage during left atrial mapping

Key Teaching Points•We present a case of redo pulmonary vein isolation complicated by perforation of the left atrium with a multipolar mapping catheter during electroanatomical mapping at the inferior base of the left atrial appendage (LAA). The cause of the acute cardiac tamponade as demonstrated during surgical repair was a tear in the LAA that might have been facilitated by a local lesion from previous ablation.•The advent of multipolar mapping catheters has greatly increased the speed of obtaining 3-dimensional maps. Their flexible splines are generally not prone to exert extensive pressure on the myocardium. However, advancing the catheter out of a long sheath in close proximity to the atrial wall may cause the catheter to act “like a spear”; therefore, it is safer to advance the catheter to the tip of the sheath and then withdraw the sheath to expose the catheter.•Electroanatomical mapping and image integration allow precise catheter visualization during electrophysiology studies. However, single projections may be misleading. Therefore, catheter position should always be ascertained using different view angles. •We present a case of redo pulmonary vein isolation complicated by perforation of the left atrium with a multipolar mapping catheter during electroanatomical mapping at the inferior base of the left atrial appendage (LAA). The cause of the acute cardiac tamponade as demonstrated during surgical repair was a tear in the LAA that might have been facilitated by a local lesion from previous ablation.•The advent of multipolar mapping catheters has greatly increased the speed of obtaining 3-dimensional maps. Their flexible splines are generally not prone to exert extensive pressure on the myocardium. However, advancing the catheter out of a long sheath in close proximity to the atrial wall may cause the catheter to act “like a spear”; therefore, it is safer to advance the catheter to the tip of the sheath and then withdraw the sheath to expose the catheter.•Electroanatomical mapping and image integration allow precise catheter visualization during electrophysiology studies. However, single projections may be misleading. Therefore, catheter position should always be ascertained using different view angles.