Conventional pulmonary vein isolation compared with the "box isolation" method: A randomized clinical trial

Karuna Chilukuri, Daniel Scherr, Darshan Dalal, Alan Cheng, David Spragg, Saman Nazarian, Bernadette D. Barcelon, Joseph E. Marine, Hugh Calkins, Charles A. Henrikson

    Research output: Contribution to journalArticle

    10 Scopus citations


    Purpose: Esophageal injury is a potential complication with radiofrequency ablation in the posterior wall of the left atrium (LA). The "box isolation" method isolates the posterior LA wall including the pulmonary veins without ablation on the posterior LA wall. This study compares the acute and long-term efficacy of the box isolation method with conventional circumferential pulmonary vein isolation (PVI) for catheter ablation of AF. Methods: Twenty-nine patients (age 60 ± 9 years, 62% male, 79% paroxysmal) with drug refractory AF underwent catheter ablation. Sixteen of the 29 patients (55%) underwent box isolation. Recurrence of AF was detected by checking the daily recorded rhythm strip on a portable home ECG monitor, irrespective of the symptoms. Mean follow-up duration was 10 ± 2 months. Results: Complete isolation of the posterior LA using box isolation lesions was achieved in three of 16 (19%) patients. The other 13 patients underwent creation of additional lesions until all PVs were isolated. Of the 16 patients who underwent box isolation, four patients (25%) had complete success, six patients (38%) had improvement, and the remaining six patients (37%) had failure. Of the 13 patients who underwent the standard PV isolation, two patients (15%) had complete success, eight patients (62%) had improvement, and the remaining three patients (23%) had failure (p = 0.44). Conclusion: In this pilot study, the efficacy of box isolation is similar to the circumferential PVI for catheter ablation of AF. Few patients achieved PVI with box method alone. Based on these results, we do not recommend the box isolation strategy.

    Original languageEnglish (US)
    Pages (from-to)137-146
    Number of pages10
    JournalJournal of Interventional Cardiac Electrophysiology
    Issue number2
    StatePublished - Nov 1 2011



    • Atrial fibrillation
    • Box isolation
    • Catheter ablation
    • Efficacy
    • Pulmonary vein isolation

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Physiology (medical)

    Cite this

    Chilukuri, K., Scherr, D., Dalal, D., Cheng, A., Spragg, D., Nazarian, S., Barcelon, B. D., Marine, J. E., Calkins, H., & Henrikson, C. A. (2011). Conventional pulmonary vein isolation compared with the "box isolation" method: A randomized clinical trial. Journal of Interventional Cardiac Electrophysiology, 32(2), 137-146.