Does the presence of left atrial low-voltage areas predict post-PVI recurrence of AF/AT in patients with non-valvular atrial fibrillation?
The presence and burden of left atrial low-voltage areas significantly predict atrial fibrillation or atrial tachycardia recurrence after pulmonary vein isolation, supporting their use in preoperative risk stratification.
To systematically evaluate the role of left atrial low-voltage areas (LVA) as a preoperative risk marker of atrial fibrillation/atrial tachycardia (AF/AT) recurrence following pulmonary vein isolation (PVI) in patients with non-valvular AF. A comprehensive literature search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted up to November 29, 2025, to identify eligible cohort studies assessing AF/AT recurrence outcomes in patients undergoing PVI. Random- or fixed-effects models were used to calculate pooled hazard ratios (HRs) with 95% confidence intervals (CIs). Subgroup and meta-regression analyses were performed to explore the sources of heterogeneity. Study quality was assessed using the Newcastle-Ottawa Scale. A meta-analysis of 15 observational studies (n = 3,957) was performed to assess the association between LVA (defined as bipolar voltage < 0.5 mV) and post-PVI recurrence of AF/AT. LVA presence was significantly associated with an increased risk of AF/AT recurrence. The overall pooled estimate yielded an OR of 2.35 (95% CI: 1.86–2.97), while the adjusted OR following trim-and-fill correction for publication bias was 1.86 (95% CI: 1.47–2.36). Subgroup analysis revealed that LVA had the strongest association with AF/AT recurrence in mixed AF cohorts (paroxysmal and persistent AF), with a pooled OR of 2.75 (95% CI: 2.01–3.77). In pure persistent AF cohorts, the association was attenuated (OR = 1.63, 95% CI: 1.20–2.21). Studies that stratified patients by LVA burden (high vs. low) demonstrated a stronger association with recurrence (pooled OR = 2.74, 95% CI: 2.01–3.74) compared to those using a simple presence/absence classification. LVA is associated with AF/AT recurrence after PVI, with both the presence of LVA and its extent (burden) independently influencing recurrence risk. This supports the use of LVA in preoperative risk stratification and individualized treatment strategies.
Cao et al. (Wed,) studied this question.