Left atrial voltage-based substrate modification after PVI in persistent AF patients with low-voltage zones improved freedom from recurrence compared to PVI alone (72% vs 38%, P<0.001).
Cohort (n=117)
Does LVZ-based substrate modification after PVI reduce recurrence of atrial fibrillation in patients with persistent AF and low-voltage zones?
Targeted ablation of low-voltage zones in addition to pulmonary vein isolation significantly improves freedom from atrial fibrillation recurrence in patients with persistent AF and fibrotic substrates.
Absolute Event Rate: 72% vs 38%
p-value: p=<0.001
BACKGROUND: Low-voltage zones (LVZs) represent fibrotic tissue and are substrates for atrial fibrillation (AF). We hypothesized that LVZ-based substrate modification along with pulmonary vein isolation (PVI) would improve outcomes in persistent AF (PeAF) patients with LVZs, whereas PVI alone would work in patients without LVZs. METHODS AND RESULTS: Voltage mapping of the left atrium (LA) was performed during sinus rhythm in 101 PeAF patients in whom LVZ was defined as an area with bipolar electrograms <0.5 mV. Thirty-nine patients had LVZs and underwent ablation of the entire LVZ area after PVI (LVZabl group). In the remaining 62 patients without LVZs, PVI alone was performed with no further substrate modifications (PVI group). An additional group of 16 consecutive PeAF patients with LVZ did not undergo any substrate modification after PVI and were used as a comparison group (LVZnon-abl group) despite having similar size of LVZs to that in the LVZabl group. After a single session, 28 (72%) patients in the LVZabl group had no recurrence, whereas 49 (79%) patients in the PVI group had no recurrence during 18 ± 7 months of follow-up (log-rank, P = 0.400). In the LVZnon-abl group, only 6 patients (38%) had no recurrence during 32 ± 7 months of follow-up, even after a mean number of sessions of 1.8 (log-rank, P < 0.001, compared with the LVZabl group). CONCLUSIONS: Additional LVZ-based substrate modification after PVI improved the outcome in PeAF patients with LVZs, whereas PVI alone worked in patients without LVZs, even in those with PeAF.
Yamaguchi et al. (Sat,) conducted a cohort in Persistent Atrial Fibrillation (n=117). LVZ-based substrate modification after PVI vs. PVI alone was evaluated on No recurrence of atrial fibrillation (p=<0.001). Left atrial voltage-based substrate modification after PVI in persistent AF patients with low-voltage zones improved freedom from recurrence compared to PVI alone (72% vs 38%, P<0.001).