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Figure 1. Right coronary artery injury after radiofrequency ablation of the cavotricuspid isthmus. (A) Fluoroscopic radiograph (left anterior oblique view) depicts the ablation catheter (red arrow) placed at 6 o’clock position on the cavotricuspid isthmus. During the procedure, the patient developed chest pain with ST- segment elevation in the inferior surface electrocardiogram leads. (B) Emergent coronary angiography revealed near-total occlusion of the distal right coronary artery (white arrow). (C) Follow-up cardiac computed tomography post-revascularization revealed the location of the stenotic segment of the right coronary artery (white arrow) behind the pectinate muscles. This volume-rendered virtual dissection image is viewed from the right posterior oblique view and cranial direction. Multiplanar reconstruction image (C) top-right insertion viewed from the right anterior oblique direction reveals the distance between the right atrial vestibule (black arrow) and the affected right coronary artery (white arrow) is 1.3 millimeters at the pocket beneath the pectinate muscle. (D) Dissection image viewed from the right anterior oblique direction exhibits the proximity of the catheter tip to the distal right coronary artery (white arrow) during cavotricuspid isthmus ablation. L: left coronary aortic sinus; N: non-coronary aortic sinus; R: right coronary aortic sinus; mm: millimeters.