The presence of left atrial posterior wall fibrillation despite restoration of sinus rhythm after posterior box ablation

Introduction Catheter ablation plays an important role in the management of persistent atrial fibrillation (AF), though recurrences of AF following ablation in patients with this condition remains high. There is general agreement that catheter ablation for AF should include pulmonary vein antral isolation (PVAI). The location and extent of ablation that should be performed beyond PVAI for the management of persistent AF remains uncertain. Although controversial, the targeting of the posterior left atrial wall for ablation beyond isolation of the pulmonary veins (PVs) has been promoted by some operators. We present a case demonstrating the potential importance in some patients of targeting the posterior wall for ablation.