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Conventional pulmonary vein isolation compared with the “box isolation” method: a randomized clinical trial

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

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.

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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.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Karuna Chilukuri, Daniel Scherr, Darshan Dalal, Alan Cheng, David Spragg, Saman Nazarian, Bernadette D. Barcelon, Joseph E. Marine, Hugh Calkins & Charles A. Henrikson

  2. Division of Cardiology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria

    Daniel Scherr

  3. The Johns Hopkins Hospital, 600 North Wolfe Street, Carnegie 592, Baltimore, MD, 21287-0409, USA

    Charles A. Henrikson

Authors
  1. Karuna Chilukuri
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  2. Daniel Scherr
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  3. Darshan Dalal
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  4. Alan Cheng
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  7. Bernadette D. Barcelon
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  8. Joseph E. Marine
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  9. Hugh Calkins
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  10. Charles A. Henrikson
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Corresponding author

Correspondence to Charles A. Henrikson.

Additional information

Clinical trial number:

NCT01091597

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Chilukuri, K., Scherr, D., Dalal, D. et al. Conventional pulmonary vein isolation compared with the “box isolation” method: a randomized clinical trial. J Interv Card Electrophysiol 32, 137–146 (2011). https://doi.org/10.1007/s10840-011-9587-8

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  • DOI: https://doi.org/10.1007/s10840-011-9587-8

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