The comparison of epicardial focused ultrasound circumferential pulmonary vein ablation and BOX ablation—results from experimental acute atrial fibrillation

  • Shaojie Chen
  • Zhiyu Ling
  • Yuehui YinEmail author
  • Chengzhi Li
  • Bo Zhang
  • Bernhard Zrenner
  • Mitchell W. Krucoff



The purpose of this study was to compare the efficacy of focused ultrasound circumferential pulmonary vein ablation (CPVa) and BOX ablation (BOXa) in an acute atrial fibrillation (AF) model.


Twenty mongrel dogs were divided into either CPVa or BOXa groups. CPV or BOX focused ultrasonic ablation was conducted in each group after successful establishment of the AF model. Before-and-after ablation left atrial effective refractory period (LAERP), AF inducibility, and induced AF lasting time were measured in both groups.


The LAERP after AF model establishment was significantly shorter than that before establishment (102 ± 10 vs. 140 ± 10 ms, p < 0.01, in the CPVa group; 105 ± 8 vs. 139 ± 11 ms, p < 0.01, in the BOXa group). The AF inducibility after ablation was significantly lower than that before ablation in the two groups (98% vs. 28%, p < 0.01, in the CPVa group; 97% vs.14%, p < 0.01, in the BOXa group), and the induced AF lasting time after ablation was significantly shorter than that before ablation in both groups (233 ± 40 vs. 70 ± 29 s, p < 0.01, in the CPVa group; 240 ± 41 vs. 34 ± 22 s, p < 0.01, in the BOXa group). On intergroup comparison, AF inducibility and induced AF lasting time after ablation were significantly lower/shorter in the BOXa group than those in the CPVa group (14% vs. 28%, p = 0.021; 34 ± 22 vs. 70 ± 29 s, p = 0.048, respectively).


In the experimental AF model, the epicardial focused ultrasound BOX ablation may be more effective to prevent the recurrence of AF compared with the CPV approach.


Atrial fibrillation Focused ultrasound ablation BOX ablation Circumferential pulmonary vein ablation 



Atrial fibrillation


Box ablation


Circumferential pulmonary vein ablation


Left atrial effective refractory period


Induced AF lasting time

LA (A)

Left atria (appendage)

RA (A)

Right atria (appendage)

L (R) PV

Left (right) pulmonary vein



This study was supported by the Health Bureau, Science Committee, ChongQing and Natural Science Foundation, China.

Conflicts of interest



  1. 1.
    Haissaguerre, M., Jais, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. The New England Journal of Medicine, 339, 659–666.PubMedCrossRefGoogle Scholar
  2. 2.
    Chen, S. A., Hsieh, M. H., Tai, C. T., Tsai, C. F., Prakash, V. S., Yu, W. C., et al. (1999). Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: Electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation, 100, 1879–1886.PubMedCrossRefGoogle Scholar
  3. 3.
    Kumagai, K., Muraoka, S., Mitsutake, C., Takashima, H., & Nakashima, H. (2007). A new approach for complete isolation of the posterior left atrium including pulmonary veins for atrial fibrillation. Journal of Cardiovascular Electrophysiology, 18, 1047–1052.PubMedCrossRefGoogle Scholar
  4. 4.
    Lin, W. S., Tai, C. T., Hsieh, M. H., Tsai, C. F., Lin, Y. K., Tsao, H. M., et al. (2003). Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy. Circulation, 107, 3176–3183.PubMedCrossRefGoogle Scholar
  5. 5.
    Kalifa, J., Tanaka, K., Zaitsev, A. V., Warren, M., Vaidyanathan, R., Auerbach, D., et al. (2006). Mechanisms of wave fractionation at boundaries of high-frequency excitation in the posterior left atrium of the isolated sheep heart during atrial fibrillation. Circulation, 113, 626–633.PubMedCrossRefGoogle Scholar
  6. 6.
    Markides, V., Schilling, R. J., Ho, S. Y., Chow, A. W., Davies, D. W., & Peters, N. S. (2003). Characterization of left atrial activation in the intact human heart. Circulation, 107, 733–739.PubMedCrossRefGoogle Scholar
  7. 7.
    Sanders, P., Berenfeld, O., Hochini, M., Hocini, M., Jais, P., Vaidyanathan, R., et al. (2005). Spectral analysis identifies sites of high-frequency activity maintaining atrial fibrillation in humans. Circulation, 112, 789–797.PubMedCrossRefGoogle Scholar
  8. 8.
    Groh, M. A., Binns, O. A., Burton, H. G., Champsaur, G. L., Ely, S. W., & Johnson, A. M. (2008). Epicardial ultrasonic ablation of atrial fibrillation during concomitant cardiac surgery is a valid option in patients with ischemic heart disease. Circulation, 118(14 Suppl), S78–S82.PubMedCrossRefGoogle Scholar
  9. 9.
    Ninet, J., Roques, X., Seitelberger, R., Deville, C., Pomar, J. L., Robin, J., et al. (2005). Surgical ablation of atrial fibrillation with off-pump, epicardial, high-intensity focused ultrasound: Results of a multicenter trial. The Journal of Thoracic and Cardiovascular Surgery, 130, 803–809.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Shaojie Chen
    • 1
  • Zhiyu Ling
    • 1
  • Yuehui Yin
    • 1
    Email author
  • Chengzhi Li
    • 2
  • Bo Zhang
    • 1
  • Bernhard Zrenner
    • 3
  • Mitchell W. Krucoff
    • 4
  1. 1.The Department of CardiologyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
  2. 2.Biomedical Engineering CollegeChongqing Medical UniversityChongqingChina
  3. 3.Medizinische KlinikKrankenhaus Landshut/AchdorfLandshutGermany
  4. 4.Duke University Medical CenterDurhamUSA

Personalised recommendations