Clinical outcome when left atrial posterior wall box isolation is included as a catheter ablation strategy in patients with persistent atrial fibrillation

Abstract

These results suggest that the strategy of left atrial box isolation is safe and effective, worthy of further evaluation in a multicentre registry.

The use of an esophageal catheter to check the results of left atrial posterior wall isolation in the treatment of atrial fibrillation

“…This study may have been confounded by the addition of a nonelectrophysiologically verified mitral isthmus line and an unstated percentage of patients in which verified posterior wall isolation may not have been achieved. Data are accumulating supporting the value of the “box” lesion set with guidelines supporting left atrial posterior wall isolation with a IIb recommendation; however, randomized data are limited and further research clearly needed.…”

“…This has led to the use of lesion sets such as left atrial posterior wall isolation (LAPWI—the “box” lesion pattern) based on the modified Cox‐Maze surgical technique created via catheter, surgery, or hybrid approaches. Series in persistent and long‐standing atrial fibrillation have shown promising results, but multicenter randomized trial data are lacking.…”

Impact of left atrial box surface ratio on the recurrence after ablation for persistent atrial fibrillation

“…Both histological and electrophysiological determinants of AF, such as fibrosis, drivers and rotors are frequently found within the (inferior part of the) posterior wall of the left atrium (LA), which may be explained by a common embryologic origin with the PVs . Several studies have demonstrated that catheter ablation of the posterior wall, in addition to PVI, improves ablation outcome . Similarly, a surgical approach aiming to isolate the posterior wall resulted in 76% free of AF recurrences in patients with long‐standing persistent AF …”

“…1 However, PVI alone in patients catheter ablation of the posterior wall, in addition to PVI, improves ablation outcome. 11,12 Similarly, a surgical approach aiming to isolate the posterior wall resulted in 76% free of AF recurrences in patients with long-standing persistent AF. 13 The insertion of the PVs in the LA can be highly variable between patients.…”

Clinical outcome when left atrial posterior wall box isolation is included as a catheter ablation strategy in patients with persistent atrial fibrillation

“…The rationale behind isolation of left atrial wall is based on its common embryonic origin with that of the pulmonary veins and the frequent finding of drivers and rotors in this area. In our small single centre study [2], we sought to evaluate a strategy of PVI plus posterior left atrial box isolation, consisting of a left atrial (LA) roof line and inferior transverse line in a group of 100 patients whose pattern of AF was predominantly persistent (72 % ). Isolation of the posterior left atrial wall was achieved in all but one of our patients.…”