Is It Necessary to Achieve a Complete Box Isolation in the Case of Frequent Esophageal Temperature Rises? Feasibility of Shifting to a Partial Box Isolation Strategy for Patients With Non-Paroxysmal Atrial Fibrillation.
There are some cases with frequent luminal esophageal temperature (LET) rises despite titrating the radiofrequency energy while creating a linear lesion for the Box isolation of atrial fibrillation (AF). Little is known about the feasibility of redesigning the ablation lines for a modified Box isolation strategy to prevent fatal esophageal injury in those cases.



Two hundred and seventeen patients who underwent a Box isolation of non-paroxysmal AF were evaluated. We divided them into 2 groups, patients in whom a box lesion set of the entire posterior left atrium had been achieved (complete Box isolation [CBI]; n = 157) and those in whom 2 additional peri-esophageal vertical lines were created at both the right and left ends of the esophagus, and those areas were left with an incomplete isolation when frequent rapid LET rises above 39.0 °C were observed while creating the floor line (partial Box isolation [PBI]; n = 60). During 20.1 ± 13.9 months of follow-up, the arrhythmia-free rates were 54.1% in the CBI group versus 48.3% in the PBI group (P = 0.62). In the second session, a complete Box isolation was highly achieved even in the PBI group (94.3% vs. 83.3%, respectively; P = 0.17) and after 2 procedures, the arrhythmia-free rates increased to 75.2% vs. 68.3%, respectively (P = 0.34). There was no symptomatic esophageal injury in the PBI group.



In the case of frequent LET rises while creating the linear lesions for the Box isolation strategy for non-paroxysmal AF, shifting to the PBI strategy was feasible.
Heart Rhythm Center, Hayama Heart Center, Shimoyamaguchi, Hayama-cho, Miura-gun, Kanagawa, Japan.
Satoshi
S
Higuchi
Heart Rhythm Center, Hayama Heart Center, Shimoyamaguchi, Hayama-cho, Miura-gun, Kanagawa, Japan.
Hiroshi
H
Sohara
Heart Rhythm Center, Hayama Heart Center, Shimoyamaguchi, Hayama-cho, Miura-gun, Kanagawa, Japan.
Yoshinori
Y
Nakamura
Heart Rhythm Center, Hayama Heart Center, Shimoyamaguchi, Hayama-cho, Miura-gun, Kanagawa, Japan.
Minoru
M
Ihara
Heart Rhythm Center, Hayama Heart Center, Shimoyamaguchi, Hayama-cho, Miura-gun, Kanagawa, Japan.
Yoshio
Y
Yamaguchi
Department of Cardiology, Tokyo Women's Medical University, Kawada-cho, Shinjuku-ku, Tokyo, Japan.
Morio
M
Shoda
Department of Cardiology, Tokyo Women's Medical University, Kawada-cho, Shinjuku-ku, Tokyo, Japan.
Nobuhisa
N
Hagiwara
Heart Rhythm Center, Hayama Heart Center, Shimoyamaguchi, Hayama-cho, Miura-gun, Kanagawa, Japan.
Shutaro
S
Satake
D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001833:Body Temperature Regulation; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D022062:Electrophysiologic Techniques, Cardiac; D004947:Esophagus / Q000503:physiopathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013821:Thermometers; D013997:Time Factors; D016896:Treatment Outcome
Box isolation lesions; atrial fibrillation; catheter ablation; esophageal lesions; pulmonary vein isolation