1 INTRODUCTIONRadiofrequency ablation has been demonstrated to be a low-risk and effective treatment for eliminating premature ventricular complexes (PVC).1,2 The retrograde transaortic approach is a widely used access route for the mapping and ablation of ventricular arrhythmias arising from the left ventricle, including the papillary muscles.1 It has been reported that some complications were associated with the retrograde transaortic approach, including iatrogenic aortic dissection, coronary damage, valve leaflets damage, complete atrioventricular block and so on.1,3 However, acute ischemic stroke (AIS) associated with the retrograde transaortic manipulation during radiofrequency ablation of PVC was rarely reported.4 In this case report, we shared a case of AIS encountered after the retrograde transaortic manipulation, during a procedure of PVC ablation.2 CASE HISTORYA 66-year-old woman (Height 164cm, Weight 72Kg) was referred for radiofrequency ablation of frequent PVC (Figure 1A), after the treatment of which by medication had been ineffective. She had a history of palpitation for one year. Her PVC burden was 14.5%, with a total of 12735 PVCs during the 24-hour Holter. Regular examination confirmed the diagnosis of hypercholesteremia (total cholesterol 6.08mmol/L, low-density lipoprotein cholesterol 4.16 mmol/L). No other disease (hypertension, diabetic mellitus, stroke) was recorded. Before the procedure, transthoracic echocardiography revealed the patient had normal cardiac diameters and normal left ventricular ejection function (68%).

Introduction Left atrial posterior wall (LAPW) isolation may be performed as an additional atrial fibrillation (AF) ablation strategy based on pulmonary vein isolation. A modified posterior-inferior line (MPL) was proposed for reducing esophageal injury. The aim of this study was to evaluate the anatomical characteristics of the MPL, compared with the CPL. Methods and Results Multidetector computed tomography was performed in 102 consecutive AF patients (male/female = 60/42) preoperative, and the parameters were evaluated as follows: the distance from MPL and CPL to the esophagus, fat pad presence and thickness in the course of MPL and CPL, and the esophageal route below CPL. The average distance from the MPL to the esophagus was longer than from CPL to the esophagus (3.7 ± 1.5mm vs 1.7 ± 0.4mm, P < 0.001). Fat pad presence was higher in the course of MPL than CPL. The myocardium tissue and fat pad under MPL was thicker than under CPL (2.9 ± 1.1mm vs 1.6 ± 0.3mm, P < 0.001; 1.4 ± 0.6mm vs 0.9 ± 0.2mm, P < 0.001), respectively. In patients whose esophagus was unconfined in a triangular space at the left inferior pulmonary vein level, the average distance from MPL to esophagus was longer than the confined patients (4.0 ± 1.7mm vs 3.2 ± 1.0mm, P = 0.001). Conclusion The MPL was far away from the esophagus with thicker myocardium tissue and more fat pad than the CPL; thus, MPL could serve as a favorable alternative in linear ablation for LAPW isolation.