Esophageal injury is a rare but serious complication of atrial fibrillation (AF) ablation. To minimize esophageal injury, our persistent AF (PerAF) protocol involves complete left atrial posterior wall (LAPW) and pulmonary vein (PV) isolation (box isolation), with a centerline away from the esophagus. However, there has been a concern that extensive LA isolation might deteriorate LA function. There has been a paucity of data on LA remodeling after box isolation. Therefore, we compared LA size pre- and post-box isolation with an LAPW centerline in patients with PerAF.

Patients who underwent catheter ablation (CA) for PerAF between November 2016 and December 2018 were retrospectively evaluated.

The LAPW, including all PVs, was completely isolated in 105 consecutive patients (75 men; mean age: 68 ± 10 years) with PerAF, including 58 patients with long-standing PerAF. During a follow-up of 660 ± 332 days, 76 patients (72%) were arrhythmia-free. The LA dimension (38 ± 6 mm versus 42 ± 7 mm; P < 0.0001) and volume index (38 ± 13 mL/m² versus 47 ± 14 mL/m²; P < 0.0001) at 6 months post-ablation were significantly decreased in patients who maintained sinus rhythm compared to pre-ablation. In patients with recurrent AF/atrial tachycardia (AT), these parameters were also significantly decreased (P < 0.001, respectively).

Box isolation with a posterior centerline has no esophageal complications and a high clinical success rate in patients with PerAF. Reverse remodeling could be achieved even when using extensive isolation of the PV and LAPW in patients with PerAF.

食管损伤是房颤 (AF) 消融术的一种罕见但严重的并发症。为了尽量减少食道损伤，我们的持续性 AF (PerAF) 协议涉及完全左心房后壁 (LAPW) 和肺静脉 (PV) 隔离（框隔离），中心线远离食道。然而，有人担心广泛的 LA 隔离可能会降低 LA 的功能。关于盒子隔离后 LA 改造的数据很少。因此，我们在 PerAF 患者中比较了 LA 大小的盒前和盒后隔离与 LAPW 中心线。

回顾性评估了 2016 年 11 月至 2018 年 12 月期间因 PerAF 接受导管消融（CA）的患者。

LAPW，包括所有 PV，在 105 名连续的 PerAF 患者（75 名男性；平均年龄：68 ± 10 岁）中被完全隔离，其中包括 58 名患有长期 PerAF 的患者。在 660 ± 332 天的随访期间，76 名患者 (72%) 无心律失常。消融后 6 个月的 LA 尺寸（38 ± 6 mm 对 42 ± 7 mm；P < 0.0001）和体积指数（38 ± 13 mL/m ²对 47 ± 14 mL/m ²；P < 0.0001）显着与消融前相比，维持窦性心律的患者减少。在复发性房颤/房性心动过速 (AT) 患者中，这些参数也显着降低（分别为P < 0.001）。

具有后中心线的盒子隔离在 PerAF 患者中没有食管并发症和高临床成功率。即使在 PerAF 患者中使用 PV 和 LAPW 的广泛隔离，也可以实现反向重塑。