Key result
Adding LVA ablation to PVI fails to reduce atrial arrhythmia recurrence versus PVI alone.
Why the study?
Pulmonary vein isolation remains unsatisfactory for persistent atrial fibrillation, and targeting low voltage areas offers an individualized approach to substrate modification.
Does PVI plus ablation of LVAs reduce recurrence of any atrial arrhythmia compared to PVI alone in patients with persistent atrial fibrillation and LVAs?
RCT (n=257)
randomized
Does PVI plus ablation of LVAs reduce recurrence of any atrial arrhythmia compared to PVI alone in patients with persistent atrial fibrillation and LVAs?
Absolute Event Rate: 60% vs 56%
In patients with persistent atrial fibrillation and low voltage areas, adding LVA ablation to PVI does not improve freedom from arrhythmia recurrence compared to PVI alone.
Informs ablation expectations in LVA patients; extends RCT evidence on substrate-based AF strategies.
Background Pulmonary vein isolation remain unsatisfactory for the treatment of persistent atrial fibrillation. Targeting areas of low voltage represents an individual approach of substrate modification. This prospective, randomized study investigated the efficacy of ablation of areas of LVA versus PVI alone. Methods and results A total number of 257 patients undergoing de-novo catheter ablation for persistent AF were randomized to three treatment arms. Patients without LVA in SR were treated with PVI only. Patients with present LVAs were randomized to PVI only or PVI + ablation of LVAs. 162 (63%) patients did not show LVAs. 48 patients with LVAs were randomized into the PVI only group and 47 patients in the PVI+LVA. During a mean follow-up of 30 ± 6.5 months after a single procedure, 132 (81.48%) without LVAs, 27 (56%) with LVAs and PVI only and 28 (60%) with LVAs and PVI+LVA ablation did not show recurrence of any atrial arrhythmia. Conclusions Endocardial low voltage areas have a significant impact on the ablation of persistent atrial fibrillation. Recurrence rate is significantly higher in patients with LVAs. Ablation of LVAs does not have an impact on the recurrence rate. Therefore, PVI only as first ablation strategy seems to be appropriate.
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Pirozzolo et al. (2026) conducted an RCT in persistent atrial fibrillation (n=257). Pulmonary vein isolation (PVI) + ablation of low voltage areas (LVAs) vs. PVI only was evaluated on freedom from recurrence of any atrial arrhythmia. Ablation of low voltage areas in addition to pulmonary vein isolation did not improve freedom from atrial arrhythmia recurrence compared to PVI alone (60% vs 56%).
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