Comparison of Spatio‐Temporal Dispersion Electrogram Ablation and Low Voltage Zone Ablation in Patients With Persistent Atrial Fibrillation

Background Pulmonary vein isolation (PVI) alone was less effective for patients with persistent atrial fibrillation (AF) compared to those with paroxysmal AF. Although the TAILORED AF trial demonstrated the efficacy of spatio‐temporal dispersion electrogram (STDE) ablation as additional treatment for PVI, comparisons between STDE and low‐voltage zone (LVZ) remain unclear. We compared the efficacy of two different methods beyond PVI: the STDE and the LVZ ablation. Methods This retrospective observational study included 107 consecutive patients (median age, 71 years; 79 male) who underwent initial catheter ablation for persistent AF at our institution. STDE evaluation and STDE‐guided substrate modification were performed in the STDE ablation group ( n = 53). The historical control group ( n = 54) did not undergo STDE evaluation and received additional ablation based on the LVZ. The primary endpoint was the recurrence of atrial arrhythmias after the ablation up to 24 months, with a 3‐month blanking period applied. Results The number of additional ablations, including linear ablation, posterior wall isolation, and focal ablation, was significantly higher in the STDE group. The AF‐free survival rate at 24 months follow‐up after ablation was higher in the STDE group (76.3% vs. 58.4%; p = 0.027). In the multivariate Cox proportional regression analysis, prolonged AF duration (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.16–1.61; p < 0.001) and larger left atrial size (HR: 1.11, 95% CI: 1.02–1.20; p = 0.012) were independent predictors of AF recurrence. Conversely, STDE ablation was independently associated with a significantly lower risk of recurrence (HR: 0.29, 95% CI: 0.12–0.66; p = 0.004). Conclusion STDE was associated with a lower risk of AF recurrence than PVI with LVZ ablation.