Paroxysmal Atrial Fibrillation With Both Triggers and Rotational Drivers Within the Right Atrial Appendage.

A 48-year-old woman with paroxysmal atrial fibrillation (AF) underwent an electrophysiology study after 2 previous failed ablations. Noninvasive mapping suggested AF initiation from the right atrial appendage (RAA) with rotational drivers of AF in the RAA. Invasive mapping confirmed these findings. The patient was successfully treated with cryoballoon RAA isolation. (Level of Difficulty: Intermediate.).