PURPOSE: Esophageal injury is a potential complication with radiofrequency ablation in the posterior wall of the left atrium (LA). The "box isolation" method isolates the posterior LA wall including the pulmonary veins without ablation on the posterior LA wall. This study compares the acute and long-term efficacy of the box isolation method with conventional circumferential pulmonary vein isolation (PVI) for catheter ablation of AF. METHODS:Twenty-nine patients (age 60 ± 9 years, 62% male, 79% paroxysmal) with drug refractory AF underwent catheter ablation. Sixteen of the 29 patients (55%) underwent box isolation. Recurrence of AF was detected by checking the daily recorded rhythm strip on a portable home ECG monitor, irrespective of the symptoms. Mean follow-up duration was 10 ± 2 months. RESULTS: Complete isolation of the posterior LA using box isolation lesions was achieved in three of 16 (19%) patients. The other 13 patients underwent creation of additional lesions until all PVs were isolated. Of the 16 patients who underwent box isolation, four patients (25%) had complete success, six patients (38%) had improvement, and the remaining six patients (37%) had failure. Of the 13 patients who underwent the standard PV isolation, two patients (15%) had complete success, eight patients (62%) had improvement, and the remaining three patients (23%) had failure (p = 0.44). CONCLUSION: In this pilot study, the efficacy of box isolation is similar to the circumferential PVI for catheter ablation of AF. Few patients achieved PVI with box method alone. Based on these results, we do not recommend the box isolation strategy.
RCT Entities:
PURPOSE:Esophageal injury is a potential complication with radiofrequency ablation in the posterior wall of the left atrium (LA). The "box isolation" method isolates the posterior LA wall including the pulmonary veins without ablation on the posterior LA wall. This study compares the acute and long-term efficacy of the box isolation method with conventional circumferential pulmonary vein isolation (PVI) for catheter ablation of AF. METHODS: Twenty-nine patients (age 60 ± 9 years, 62% male, 79% paroxysmal) with drug refractory AF underwent catheter ablation. Sixteen of the 29 patients (55%) underwent box isolation. Recurrence of AF was detected by checking the daily recorded rhythm strip on a portable home ECG monitor, irrespective of the symptoms. Mean follow-up duration was 10 ± 2 months. RESULTS: Complete isolation of the posterior LA using box isolation lesions was achieved in three of 16 (19%) patients. The other 13 patients underwent creation of additional lesions until all PVs were isolated. Of the 16 patients who underwent box isolation, four patients (25%) had complete success, six patients (38%) had improvement, and the remaining six patients (37%) had failure. Of the 13 patients who underwent the standard PV isolation, two patients (15%) had complete success, eight patients (62%) had improvement, and the remaining three patients (23%) had failure (p = 0.44). CONCLUSION: In this pilot study, the efficacy of box isolation is similar to the circumferential PVI for catheter ablation of AF. Few patients achieved PVI with box method alone. Based on these results, we do not recommend the box isolation strategy.
Authors: Hugh Calkins; Josep Brugada; Douglas L Packer; Riccardo Cappato; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; David E Haines; Michel Haissaguerre; Yoshito Iesaka; Warren Jackman; Pierre Jais; Hans Kottkamp; Karl Heinz Kuck; Bruce D Lindsay; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Andrea Natale; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Jeremy N Ruskin; Richard J Shemin Journal: Heart Rhythm Date: 2007-04-30 Impact factor: 6.343
Authors: Louise S Jenkins; Michael Brodsky; Eleanor Schron; Mina Chung; Thomas Rocco; Ellis Lader; Martha Constantine; Robert Sheppard; Donald Holmes; Donna Mateski; Liz Floden; Marilyn Prasun; H Leon Greene; Lynn Shemanski Journal: Am Heart J Date: 2005-01 Impact factor: 4.749
Authors: Vias Markides; Richard J Schilling; Siew Yen Ho; Anthony W C Chow; D Wyn Davies; Nicholas S Peters Journal: Circulation Date: 2003-02-11 Impact factor: 29.690
Authors: Derick M Todd; Allan C Skanes; Gerard Guiraudon; Colette Guiraudon; Andrew D Krahn; Raymond Yee; George J Klein Journal: Circulation Date: 2003-12-01 Impact factor: 29.690
Authors: Jérôme Kalifa; Kazuhiko Tanaka; Alexey V Zaitsev; Mark Warren; Ravi Vaidyanathan; David Auerbach; Sandeep Pandit; Karen L Vikstrom; Robert Ploutz-Snyder; Arkadzi Talkachou; Felipe Atienza; Gérard Guiraudon; José Jalife; Omer Berenfeld Journal: Circulation Date: 2006-02-07 Impact factor: 29.690
Authors: David Tamborero; Lluís Mont; Antonio Berruezo; Maria Matiello; Begoña Benito; Marta Sitges; Barbara Vidal; Teresa M de Caralt; Rosario J Perea; Radu Vatasescu; Josep Brugada Journal: Circ Arrhythm Electrophysiol Date: 2008-12-03
Authors: Emmanouil Charitakis; Silvia Metelli; Lars O Karlsson; Antonios P Antoniadis; Konstantinos D Rizas; Ioan Liuba; Henrik Almroth; Anders Hassel Jönsson; Jonas Schwieler; Dimitrios Tsartsalis; Skevos Sideris; Elena Dragioti; Nikolaos Fragakis; Anna Chaimani Journal: BMC Med Date: 2022-05-31 Impact factor: 11.150
Authors: Christian Sohns; Leonard Bergau; Joachim Seegers; Lars Lüthje; Dirk Vollmann; Markus Zabel Journal: J Interv Card Electrophysiol Date: 2014-06-19 Impact factor: 1.900
Authors: René Worck; Samuel K Sørensen; Arne Johannessen; Martin Ruwald; Martin Haugdal; Jim Hansen Journal: J Cardiovasc Electrophysiol Date: 2022-05-31 Impact factor: 2.942
Authors: Prabhat Kumar; Ayotunde M Bamimore; Jennifer D Schwartz; Eugene H Chung; Anil K Gehi; Andy C Kiser; James P Hummel; J Paul Mounsey Journal: J Am Heart Assoc Date: 2016-09-23 Impact factor: 5.501