What does this research mean for the field?

In non-diabetic patients with wide LVAs, PVI+LVA ablation reduces AF recurrence to 36% compared to 55% with PVI alone, but worsens outcomes in diabetic patients with narrow LVAs (58% vs 30%). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

This analysis investigates how diabetes status affects outcomes following LVA ablation after PVI in persistent AF patients.

February 8, 2026European Heart Journal

LVA ablation following the PVI strategy showed better outcomes in diabetic patients with wide LVA compared to narrow LVA: A Sub-Analysis of the SUPPRESS-AF Trial

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Key result

PVI+LVA ablation cuts AF/AT recurrence ~29% in wide-LVA non-diabetics but increases risk in narrow-LVA diabetics.

Why the study?

Diabetes mellitus is an established risk factor for atrial low-voltage area (LVA) formation, but the impact of diabetic status on arrhythmia recurrence after LVA ablation was unclear.

Does LVA ablation following PVI reduce AF/AT recurrence in diabetic and non-diabetic patients with persistent AF and left atrial LVAs?

Key Points

This analysis investigates how diabetes status affects outcomes following LVA ablation after PVI in persistent AF patients.
Sub-analysis of the multicenter SUPPRESS-AF trial.
Included persistent AF patients undergoing initial ablation.
Patients were randomized to PVI+LVA-ablation arm or PVI-alone arm after pulmonary vein isolation.
Primary endpoint was freedom from AF/atrial tachycardia recurrence during 1-year follow-up.
343 out of 1,347 patients had left atrial LVAs and were randomized.
Non-diabetic patients with wide LVAs had lower AT/AF recurrence in the PVI+LVA-ablation arm (35% vs. 49%).
In diabetic patients with narrow LVAs, recurrence was higher in the PVI+LVA-ablation arm (58% vs. 30%).
Outcomes were similar for non-diabetic/narrow LVA subgroup and diabetic/wide LVA subgroup.

Structured PICO

Does LVA ablation following PVI reduce AF/AT recurrence in diabetic and non-diabetic patients with persistent AF and left atrial LVAs?

Population

343 patients with persistent atrial fibrillation undergoing initial AF ablation who demonstrated left atrial low-voltage areas (LVAs ≥5 cm²) following pulmonary vein isolation (sub-analysis of 1,347 total patients)

Intervention

Low-voltage area (LVA) ablation following pulmonary vein isolation (PVI+LVA-ablation)

Comparator

Pulmonary vein isolation alone (PVI-alone)

Outcome

Freedom from atrial fibrillation (AF) or atrial tachycardia (AT) recurrence without antiarrhythmic drug use after initial ablation during 1-year follow-upcomposite

LVA ablation in addition to PVI improves outcomes in non-diabetic patients with persistent AF and wide LVAs, but may worsen outcomes in diabetic patients with narrow LVAs.

Discussion

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Implication

Avoid LVA ablation in diabetics with narrow LVAs; challenges consensus on uniform benefit in persistent AF.

Cite This Study

Ozaki et al. (2025) studied this question. PVI+LVA ablation reduced AF/AT recurrence from 49% to 35% in non-diabetics with wide LVAs, but increased recurrence from 30% to 58% in diabetics with narrow LVAs.

synapsesocial.com/papers/698827a20fc35cd7a88468ca https://doi.org/10.1093/eurheartj/ehaf784.455

Topics

Persistent AF management Atrial fibrillation AF ablation outcomes Anticoagulation in AF

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Bookmark

LVA ablation following the PVI strategy showed better outcomes in diabetic patients with wide LVA compared to narrow LVA: A Sub-Analysis of the SUPPRESS-AF Trial

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

LVA ablation following the PVI strategy showed better outcomes in diabetic patients with wide LVA compared to narrow LVA: A Sub-Analysis of the SUPPRESS-AF Trial

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

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