TY - JOUR
T1 - Conventional pulmonary vein isolation compared with the "box isolation" method
T2 - A randomized clinical trial
AU - Chilukuri, Karuna
AU - Scherr, Daniel
AU - Dalal, Darshan
AU - Cheng, Alan
AU - Spragg, David
AU - Nazarian, Saman
AU - Barcelon, Bernadette D.
AU - Marine, Joseph E.
AU - Calkins, Hugh
AU - Henrikson, Charles A.
N1 - Funding Information:
Acknowledgments Dr. Karuna Chilukuri was supported by The Norbert and Louise Grunwald Cardiac Arrhythmia Research Fund. Dr. Daniel Scherr was supported by the Erwin Schroedinger Research Grant (J2559) of the FWF—Austrian Science Fund. The Johns Hopkins Atrial Fibrillation Program is supported by the Francis Chiaramonte Foundation.
PY - 2011/11
Y1 - 2011/11
N2 - 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.
AB - 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.
KW - Atrial fibrillation
KW - Box isolation
KW - Catheter ablation
KW - Efficacy
KW - Pulmonary vein isolation
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U2 - 10.1007/s10840-011-9587-8
DO - 10.1007/s10840-011-9587-8
M3 - Article
C2 - 21614530
AN - SCOPUS:84855566785
SN - 1383-875X
VL - 32
SP - 137
EP - 146
JO - Journal of Interventional Cardiac Electrophysiology
JF - Journal of Interventional Cardiac Electrophysiology
IS - 2
ER -