Left atrial substrate ablation in addition to pulmonary vein isolation in paroxysmal atrial fibrillation using a large 28-mm cryoballoon.

We report a case of successful isolation of all pulmonary veins (PV) for symptomatic paroxysmal atrial fibrillation using a 23-mm cryoballoon with continued paroxysmal atrial fibrillation during a 3-month follow-up. Left atrial-to-PV-junction ablation was then performed 3 months after the first procedure using a larger 28-mm balloon despite unrecovered isolation of all four PV, thereby curing symptomatic atrial fibrillation in this case.