A 71-year-old male with kyphoscoliosis (Fig. 1a), persistent atrial fibrillation recurrent to amiodarone, LVEF 35%, and suspicious of tachycardiomyopathy was admitted for pulmonary veins isolation. An Agilis NxT Steerable introducer (St Jude Medical, Minnetonka, MN, USA) and an intracardiac echo (ICE) probe were advanced into the superior vena cava and right atrium, respectively.