Although left atrial (LA) remodeling has been proposed as a predictor of common cardiovascular outcomes such as atrial fibrillation (AF), stroke, and congestive heart failure, more data are required regarding whether surgical LA volume reduction translates into improved outcomes [1]. Although LA volume reduction surgery with mitral valve surgery and/or Maze procedure improve circulatory and respiratory functions related to reduction of compression to the left ventricle, bronchus, and pulmonary parenchyma [2-5], no report included patients who did not undergo mitral valve surgery; little has been reported regarding its long-term effects. We hereby report a case of LA volume reduction combined with pulmonary vein isolation, without valve surgery, whose beneficial effects on symptoms associated with heart failure, particularly left ventricular filling, respiratory function, and stroke prevention, have persisted for 6 years postoperatively. Case report A 74-year-old male with a history of two previous median sternotomies was referred to us in 2012 due to heart failure with New York Heart Association (NYHA) class III symptoms and thrombus in his giant LA. In 1980, he first underwent sternotomy