Where to Perform the Pulmonary Vein Isolation in Third‐Ablation Paroxysmal AF?

BACKGROUND: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation, although the optimal site for ablation remains controversial. METHODS AND RESULTS: We reported a 52- year-old woman with the third paroxysmal AF ablation. Mapping showed that the ostial PV ， but not the PV antrum ，was isolated. During circumferential PV antrum ablation, the atrial arrhythmias were eliminated. The roof line and superior vena cava isolation was empirically performed. During the 84-month follow-up, she was free of arrhythmias without antiarrhythmics. CONCLUSION: Isolation of the PV antrum, which was easily to be identify by image integration, should be checked and achieved for patients with AF recurrence after "successful and durable ostial PVI". CLINICAL TRIAL REGISTRATION STATEMENT: No clinical trial registration number is applicable.