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the endocardial linear lesion with the roofline resulted in conversion to sinus rhythm (Figure 1, B and C). Bilateral video-assisted thoracoscopic PV isolation is a safe, beating-heart approach for curative surgical treatment of AF. Linear lesions are known to improve the outcome of catheter ablation in patients with persistent atrial fibrillation. The left fibrous trigone line was introduced by Edgerton and colleagues. This linear lesion serves as an alternative to the endocardial mitral isthmus line extending from the left inferior PV to the mitral valve annulus. The creation of a completely transmural left fibrous trigone line can be hampered by the presence of epicardial fat. Not completely transmural lesions exhibit zones of low voltages and conduction slowing and can become pro-arrhythmic. In our patient, an incomplete left fibrous trigone line resulted in left atrial flutter. Most of these iatrogenic arrhythmias are very symptomatic. To prevent, as much as possible, such reentry circuits from occurring, it is of paramount

journal of thoracic and cardiovascular surgery

Extremely rare but potential complication of diffuse brain edema due to air embolism during lung segmentectomy with selected segmental inflation technique by syringe needle during video-assisted thoracoscopic surgery