Persistent atrial fibrillation: When the pulmonary veins are no longer the answer.

A case study of a 67‐year‐old woman with recurrent persistent atrial fibrillation (AF) and having undergone pulmonary vein isolation (PVI) is presented. Topics discussed include normal left ventricular systolic function with mild to moderate left atrial enlargement; and advent of force‐sensing catheters, high‐frequency low‐volume ventilation, and long sheaths resulting in more effective persistent PVI, the situation has become increasingly common in clinical practice.