ArticlePacing and clinical electrophysiology : PACE2019
Impact of left atrial box surface ratio on the recurrence after ablation for persistent atrial fibrillation.
Article in Pacing and clinical electrophysiology : PACE, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 11 citations in OpenAlex.
- Recurrence and non-improvement of European Heart Rhythm Association symptom scores after atrial fibrillation ablation: the role of left atrial fractal dimension.Quantitative imaging in medicine and surgery · 2025Article
- Value of Imaging in the Non-Invasive Prediction of Recurrence after Catheter Ablation in Patients with Atrial Fibrillation: An Up-to-Date Review.Reviews in cardiovascular medicine · 2023Review
- Ongoing substrate-driven atrial fibrillation "boxed" in the left atrial posterior wall with ablation: a case report.Frontiers in cardiovascular medicine · 2023Article
- Is Incomplete Left Atrial Posterior Wall Isolation Associated With Recurrence of Atrial Fibrillation After Radiofrequency Catheter Ablation?Circulation reports · 2020Article
- Left atrial effective conducting size predicts atrial fibrillation vulnerability in persistent but not paroxysmal atrial fibrillation.Journal of cardiovascular electrophysiology · 2019Article
- Impact of left atrial box surface ratio on the recurrence after ablation for persistent atrial fibrillation.Pacing and clinical electrophysiology : PACE · 2019Article
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe posterior wall of the left atrium (LA) is a well-known substrate for atrial fibrillation (AF) maintenance. Isolation of the posterior wall between the pulmonary veins (box lesion) may improve ablation success. Box lesion surface area size varies depending on the individual anatomy. This retrospective study evaluates the influence of box lesion surface area as a ratio of total LA surface area (box surface ratio) on arrhythmia recurrence.
methodsSeventy consecutive patients with persistent AF (63 ± 11 years, 53 men) undergoing computed tomography (CT) imaging and ablation procedure consisting of a first box lesion were included in this study. Box lesion surface area was measured on electroanatomical maps and total LA surface area was derived from CT. Patients were followed with 24-h electrocardiography and exercise tests at 3, 6, and 12 months after AF ablation. Arrhythmia recurrence was defined as any AF/atrial tachycardia (AT) beyond 3 months without antiarrhythmic drugs.
resultsDuring a median follow-up of 13 (interquartile range = 10-17) months, 42 (60%) patients had AF/AT recurrence. Multivariate Cox proportional regression analysis showed that a larger box surface ratio protected against recurrence (hazard ratio [HR] = 0.81; 95% confidence interval [CI] = 0.690-0.955; P = 0.012). Left atrial volume index (HR = 1.01 [0.990-1.024, P = 0.427] and a history of mitral valve surgery (HR = 2.90; 95% CI = 0.970-8.693; P = 0.057) were not associated with AF recurrence in multivariate analysis.
conclusionA larger box lesion surface area as a ratio of total LA surface area is protective for AF/AT recurrence after ablation for persistent AF.
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