The circumflex artery is in close proximity to the lateral LA and can potentially be injured during ablation at sites adjacent to its course within the CS, the lateral mitral isthmus, or the base of the LAA. Occlusion of the circumflex accounted for three of the eight cases in the above series, all presenting with ventricular fibrillation 20 and 60 minutes after mitral isthmus ablation and 6 hours after ablation at the LAA base, respectively.1233 Others have also described features of acute myocardial infarction with ST segment changes occurring during ablation at the mitral isthmus.923 These patients have variably undergone unsuccessful intracoronary vasodilators or thrombectomy and have had to progress to coronary stenting. A single case presenting 48 hours after mitral isthmus ablation with total circumflex occlusion and ventricular arrhythmia storm is described as having ongoing ventricular arrhythmia requiring ablation and defibrillator implantation, highlighting the potential for ongoing consequences as a result of coronary artery injury.1234