PVI plus ablation of low-voltage areas significantly increased freedom from atrial arrhythmia recurrence compared to conventional PVI with or without linear ablation (68% vs 42%, P=0.003).
RCT (n=124)
No
Does individually tailored PVI plus voltage-guided ablation of low-voltage areas reduce atrial arrhythmia recurrence compared to standardized PVI with or without linear ablation in ablation-naive patients with atrial fibrillation?
Individually tailored substrate modification guided by voltage mapping significantly improves arrhythmia-free survival compared to a conventional standardized linear ablation approach in patients undergoing first-time AF ablation.
Absolute Event Rate: 68% vs 42%
p-value: p=0.003
Aims: This randomized single-centre study sought to compare the efficacy and safety of pulmonary vein isolation (PVI) plus voltage-guided ablation vs. PVI with or without linear ablation depending on the type of atrial fibrillation (AF). Methods and results: Overall, 124 ablation-naive patients with paroxysmal or persistent AF were randomized to PVI with (persistent AF) or without (paroxysmal AF) additional linear ablation (control group) vs. PVI plus ablation of low-voltage areas (LVAs) irrespective of AF type. Bipolar voltage mapping was performed during stable sinus rhythm. An LVA consisted of ≥ 3 adjacent mapping points that each had a peak-to-peak amplitude ≤0.5 mV. After a mean follow-up of 12 ± 3 months, significantly more patients in the LVA ablation group were free from atrial arrhythmia recurrence >30 s off antiarrhythmic drugs (AADs) after a single procedure (primary endpoint) compared with control group patients 40/59 (68%) vs. 25/59 (42%), log-rank P = 0.003. Arrhythmia-free survival on or off AADs was found in 33/59 control group patients (56%) and in 41/59 LVA ablation group patients (70%) (adjusted log-rank P = 0.10). During the 7 day Holter monitoring period at 12 months, significantly more patients in the LVA ablation group were free from arrhythmia recurrence on or off AADs 45/50 (90%) vs. 33/46 (72%), P = 0.04. No between-group differences were observed regarding procedure duration, fluoroscopy time, and major complications. Conclusion: In this single-centre study, individually tailored substrate modification guided by voltage mapping was associated with a significantly higher arrhythmia-free survival rate compared with a conventional approach applying linear ablation according to AF type.
Kircher et al. (2017) conducted an RCT in Atrial fibrillation (n=124). PVI plus ablation of low-voltage areas vs. PVI with or without linear ablation depending on AF type was evaluated on Freedom from atrial arrhythmia recurrence >30 s off antiarrhythmic drugs after a single procedure (p=0.003). PVI plus ablation of low-voltage areas significantly increased freedom from atrial arrhythmia recurrence compared to conventional PVI with or without linear ablation (68% vs 42%, P=0.003).