Single Ring Posterior Left Atrial (Box) Isolation Results in a Different Mode of Recurrence Compared to Wide Antral Pulmonary Vein Isolation on Long Term Follow Up: Longer AF Free Survival Time but Similar Survival Time Free of Any Atrial Arrhythmia

Circep.ahajournals.org: 9/12/12

isolation of the pulmonary veins and posterior left atrium with a single ring of radiofrequency lesions (SRI) may result in fewer atrial fibrillation (AF) recurrences than wide antral pulmonary vein isolation (WAI) by abolishing extravenous AF triggers. The effect of mitral isthmus line (MIL) ablation on outcomes after SRI has not previously been assessed.

Methods and Results—We randomly assigned 220 consecutive patients (58 ± 10 years old; 82% male) with highly symptomatic AF (61% paroxysmal, 39% persistent/ longstanding persistent) to undergo either SRI or WAI. Half of each cohort was also randomly allocated to have left lateral MIL ablation (2 x 2 factorial study design). Patients were followed clinically and with 7-day Holter studies for arrhythmia recurrences.  Read more