Concomitant Isolation of the Pulmonary Veins and Posterior Wall Using a Box Lesion Set in a Patient with Persistent Atrial Fibrillation and Variant Pulmonary Venous Anatomy.

Variant pulmonary venous anatomy is common and its pre-procedural recognition through cardiac imaging facilitates a personalized approach to ablation tailored to the individual patient. Close juxtaposition of the right and left pulmonary veins is an anatomic variation that serves as an ideal substrate for creation of a single box lesion set that concomitantly isolates the pulmonary veins and posterior wall. Isolation of the posterior wall may serve as an adjunctive ablative strategy in addition to pulmonary vein isolation that facilitates maintenance of sinus rhythm among patients with persistent atrial fibrillation.