{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:21:08Z","timestamp":1760746868321,"version":"build-2065373602"},"reference-count":18,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia, with catheter ablation outcomes differing significantly between paroxysmal and persistent forms. While pulmo-nary vein isolation (PVI) remains the cornerstone of ablation, persistent AF is often associ-ated with atrial remodeling and non-pulmonary vein triggers, reducing procedural success rates and necessitating repeat interventions. However, in selected patients with minimal atrial substrate, a single PVI may achieve durable rhythm control. This case report illus-trates such a scenario in a young patient with persistent AF and tachyarrhythmia-induced cardiomyopathy (TIC). Methods: A 42-year-old previously healthy male presented with newly diagnosed persistent AF complicated by TIC and heart fail-ure (left ventricular ejection fraction [LVEF] 25%). Despite rate control, anticoagulation, guideline-directed heart failure therapy, amiodarone pretreatment, and two failed electrical cardioversions, the patient remained symptomatic. Elec-troanatomic mapping was performed to assess atrial substrate prior to radiofrequency ablation. Results: Mapping revealed no extensive low-voltage zones, indicating absence of significant atrial fibrosis. During ablation, si-nus rhythm was restored spontaneously with a single application targeting the infero-posterior aspect of the right infe-rior pulmonary vein. No additional arrhythmogenic substrate was identified. The patient maintained sinus rhythm throughout 14 months of follow-up, with marked clinical improvement, normalization of LVEF (55%), regression of atrial and ventricular enlargement, and resolution of heart failure symptoms. Quality of life, assessed by the ASTA question-naire, improved from 24 to 0 points. Conclusions: This case highlights that even in therapy-resistant persistent AF with severe structural and functional cardiac impairment, arrhythmia may be driven by discrete pulmonary vein-dependent mechanisms. Careful patient selection, particu-larly in younger individuals without advanced atrial remodeling, can identify those in whom PVI alone achieves durable rhythm control and reverse cardiac remodeling.<\/jats:p>","DOI":"10.3390\/jcm14207297","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T11:39:34Z","timestamp":1760701174000},"page":"7297","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["One Shot, One Rhythm: Termination of Refractory Persistent Atrial Fibrillation in a Young Patient via Single Pulmonary Vein Application: A Case Report"],"prefix":"10.3390","volume":"14","author":[{"given":"Jonasz","family":"Kozielski","sequence":"first","affiliation":[{"name":"Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5546-7818","authenticated-orcid":false,"given":"Alicja","family":"D\u0105browska-Kugacka","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-214 Gdansk, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2269-1880","authenticated-orcid":false,"given":"Ludmi\u0142a","family":"Dani\u0142owicz-Szymanowicz","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-214 Gdansk, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0367-4014","authenticated-orcid":false,"given":"Marek","family":"Szo\u0142kiewicz","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1093\/ehjqcco\/qcaa061","article-title":"Global, regional, and national prevalence, incidence, mortality, and risk factors for atrial fibrillation, 1990\u20132017: Results from the Global Burden of Disease Study 2017","volume":"7","author":"Dai","year":"2021","journal-title":"Eur. 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