Box Isolation for Atrial Fibrillation

Since the first report of catheter ablation curing atrial fibrillation (AF), numerous techniques have evolved, from linear ablation to segmental pulmonary vein (PV) isolation, extensive encircling PV isolation, LA linear ablation, ablation of complex fragmented atrial electrograms (CFAE) and stepwise ablation. We developed a new approach for complete isolation of the posterior LA including all PVs, namely box isolation. In the post erior LA, there are many arrhythmogenic substrates for AF, including the triggers, reentries and ganglionated plexi. Box isolation can contain these abnormal substrates in the posterior LA. Box isolation is associated with a high clinical success rate in paroxysmal AF. However, in persistent AF or longstanding persistent AF, only box isolation may not be sufficient, therefore, additional ablation at sites with CFAE outside the box area is needed to improve the clinical outcome. A hybrid approach of combining box isolation with CFAE ablation is highly effective in the majority of patients with persistent AF or longstanding persistent AF. Thus, AF ablation is an effective and safe treatment for AF that offers an excellent chance for a lasting cure.