Single Ring Posterior Left Atrial (Box) Isolation Results in Fewer AF Recurrences

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Introduction: Electrical 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). The effect of mitral isthmus line (MIL) ablation on outcomes after SRI is uncertain. Methods: We randomly assigned 220 consecutive patients (58±10 years old; 180 male) with highly symptomatic AF (135 paroxysmal, 85 persistent/longstanding persistent) to undergo either SRI or WAI, with or without additional left lateral MIL ablation. They were followed clinically and with 7-day Holter for 2.2±0.8 years. Results: Two year AF free survival was better following SRI (74±4%) than after WAI (61±5%; p=0.04) while organised atrial tachyarrhythmia (OAT) free survival was similar (67±5% vs. 65±5%; p=0.70). MIL ablation resulted in better 2 year OAT free survival in patients who had SRI (76±6% vs. 58±7%, p=0.02). Survival free of any atrial arrhythmia 2 years after one procedure was similar in all treatment allocation groups. Conclusions: SRI resulted in fewer AF recurrences compared to WAI but did not reduce overall atrial arrhythmias recurrence. MIL ablation reduces OAT recurrences in patients who had SRI.