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This study describes the feasibility of a posterior left atrium isolation as a substrate modification in addition to pulmonary vein isolation, the so\u2010called Box isolation, for elderly patients with non\u2010PAF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two hundred twenty\u2010nine consecutive patients who underwent Box isolations for drug\u2010refractory non\u2010PAF were divided into two groups according to their age; younger group comprising 175 patients aged &lt;75 years and elderly group comprising 54 patients aged \u226575 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During 23.7\u00b112.0 months of follow\u2010up, the arrhythmia\u2010free rates after one procedure were 53.1% in younger group versus 48.1% in elderly group (<jats:italic>p<\/jats:italic>=0.50). Following the second procedure, all patients had electrical conduction recoveries along the initial Box lesion. However, a complete Box re\u2010isolation was highly established in both age groups (87.1% vs. 92.9%, respectively; <jats:italic>p<\/jats:italic>=1.00). Recurrence of macro\u2010reentrant atrial tachycardia was mainly associated with the gaps through the initial Box lesion in both age groups (25.8% vs. 21.4%, p=1.00), but typical cavo\u2010tricuspid isthmus (CTI) dependent atrial flutter was significantly observed in the elderly patients\u2019 group only (all events were observed within 6 months after the initial procedure; 3.2% vs. 28.6%, <jats:italic>p<\/jats:italic>=0.009). After two procedures, the arrhythmia\u2010free rates increased to 73.1% in younger group versus 66.7% in elderly group (<jats:italic>p<\/jats:italic>=0.38). The occurrence rate of procedural\u2010related complications did not differ between the two age groups, and there were no life\u2010threatening complications even in elderly patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Box isolation of non\u2010PAF is effective and safe even in elderly patients. A prophylactic CTI ablation combined with Box isolation might be feasible to improve the long\u2010term outcome.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.joa.2016.02.002","type":"journal-article","created":{"date-parts":[[2016,3,15]],"date-time":"2016-03-15T22:33:59Z","timestamp":1458081239000},"page":"198-203","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":3,"title":["The feasibility of a Box isolation strategy for non\u2010paroxysmal atrial fibrillation in elderly 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