Comparison of high-power single-ring isolation and box isolation in elderly patients with persistent atrial fibrillation.

Background: This study evaluated the superiority of single-ring isolation (SRI) over box isolation using high power in elderly patients with persistent atrial fibrillation (PeAF).

Methods: We retrospectively studied elderly patients with PeAF who underwent primary catheter ablation. The patients were divided into the SRI group and the posterior box isolation (BOXI) group. Basic characteristics, procedural variables, complications and atrial arrhythmia recurrence rates were collected.

Results: Forty-five pairs of patients in the two groups were matched by 1:1 PSM. Compared with that in the BOXI group, the total procedure time in the SRI group was not significantly different (P = 0.340). However, there were significant reductions in the total ablation time, ring ablation lesions and number of lesions on the posterior wall in patients who underwent SRI compared to those who underwent BOXI (all P < 0.001). The cardiac troponin level in the SRI group was significantly lower (P = 0.023). There were significantly fewer mismatched three-dimensional mapping models and mismatched models per patient due to pain-induced movement in the SRI group (all P < 0.05). The questionnaires revealed that the pain score was significantly lower in the SRI group than in the BOXI group (P < 0.001). In addition, significantly fewer patients with SRI than with BOXI experienced gastrointestinal symptoms after the procedure (15.56% vs. 37.78%, P = 0.017). K‒M analysis revealed no significant difference in atrial arrhythmia-free survival at 12 months between the SRI and BOXI patients (P > 0.05).

Conclusions: High-power SRI is safe and feasible and may be superior to the BOXI for experience of elderly patients with PeAF.