Clinical implication
To the best of our knowledge, this is the first study to identify a relationship between the ACZ and the LVA/LA anatomical CoAs in patients with AF. To improve the outcome after CA for AF, a more detailed understanding of the LA activation is essential. Consequently, the assessment of the ACZ might have a critical implication in risk stratification of atrial tachyarrhythmias recurrence after the CA, and could be helpful in providing an appropriate new strategy for CA. A prior study suggested that the LA posterior wall plays an important role in both initiation and the maintenance of AF, and a recent systematic review showed the efficacy of posterior wall isolation for AF.19 These findings indirectly suggest that the posterior ACZ may play an important role in patients with AF. However, we did not investigate the association between the ACZ and the recurrence of AF. Further study will be necessary to determine which position of the ACZ is important in AF.