Left Atrial Appendage Clip Reentry: The Case for Ablation From the Appendage to Left Pulmonary Veins

Convergent hybrid atrial fibrillation ablation combines epicardial posterior left atrial ablation with catheter pulmonary vein isolation. Concomitant left atrial appendage AtriClip placement has recently been included to mitigate stroke risk. We describe a 72-year-old woman with long-standing persistent atrial fibrillation in whom atrial flutter with reentry encircling the AtriClip developed 18 months after a successful convergent procedure.