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Figure 1 Catheter-induced mechanical trauma to a manifest left posterolateral accessory pathway during atrial fibrillation when manipulating the ablation catheter below the mitral annulus (Patient 7A). Shown are electrocardiographic leads I, II, III and V1 as well as intracardiac electrograms from the ablation (ABL) catheter (bipolar and unipolar) and the distal coronary sinus (CS-1 and CS-2). Note the early ventricular activation at the ablation catheter immediately prior to mechanical trauma.