This study shows that it is possible to achieve complete isolation of the posterior LA including all PVs without posterior vertical lesions. Box isolation is associated with a high clinical success rate.

Heterogeneous conduction was observed at the roof and inferior region of the posterior LA in most of these AF patients. The conduction properties of the posterior LA are affected by the direction of the wavefronts, and this may play an important role in the initiation and maintenance of AF. The complete isolation of the posterior LA may prevent AF.

Introduction: Radiofrequency catheter ablation (RFCA) that targets pulmonary veins (PV) is an established treatment for paroxysmal atrial fibrillation (PAF). Recent studies have demonstrated that RFCA can eliminate PAF in over 90% of patients. However, the effectiveness for persistent or permanent AF has not been clarified.Methods and Results: 27 patients (29%) had persistent or permanent AF. RFCA including PV antrum isolation (PVAI) was performed using a circular mapping catheter in the patients with persistent or permanent AF. Four patients (15%) underwent only PVAI. Thirteen patients (48%) underwent PVAI and left atrium roof and/or mitral isthmus linear ablation. Ten patients (37%) underwent PVAI and RFCA to an area with complex fractionated atrial electrograms. All patients were observed for over a year. After repeat ablation at mean followup of 16 AE 5 months, 23 patients (85%) had normal sinus rhythm and were free of symptomatic AF or atrial flutter. Three patients required antiarrhythmic drugs to maintain sinus rhythm during follow-up period. One patient had a transient phrenic nerve injury. Two patients were documented with sustained atrial tachycardia (AT). Mapping in 2 patients showed a macro reentry AT due to gaps in the ablation lines and further ablation was needed. No other complications including PV stenosis occurred.Conclusions: The present study demonstrated that RFCA is an effective and feasible treatment for persistent or permanent AF. (J Arrhythmia 2007; 23: 229-235)

We describe the case of an 85-year-old (Fig. 2) (Fig. 4) and no pseudoaneurysm. Therefore, the patient was discharged without any complications and has remained asymptomatic. DiscussionCardiac rupture following AMI is considered to be sudden

No abstract