Key result
Additional low voltage area modification significantly reduced the risk of atrial tachyarrhythmia recurrence compared to CPVI alone in older patients with paroxysmal (HR 0.41; 95% CI 0.19-0.81) and persistent AF (HR 0.35; 95% CI 0.12-0.98).
Why the study?
Age affects low voltage areas (LVAs) in AF patients, but the potential benefit of LVA modification in older AF patients remains to be investigated.
Does additional low voltage area (LVA) modification reduce the recurrence of atrial tachyarrhythmias in older patients with atrial fibrillation undergoing circumferential pulmonary vein isolation?
RCT (n=510)
randomized
Does additional low voltage area (LVA) modification reduce the recurrence of atrial tachyarrhythmias in older patients with atrial fibrillation undergoing circumferential pulmonary vein isolation?
Additional low voltage area modification during circumferential pulmonary vein isolation significantly reduces the recurrence of atrial tachyarrhythmias in older patients (≥65 years) with both paroxysmal and persistent atrial fibrillation.
Additional LVA modification was associated with lower ATA recurrence in older AF patients; hypothesis-generating and requires randomized confirmation.
BACKGROUND: Age has been found as an important factor affecting the low voltage area (LVA) in patients with atrial fibrillation (AF). This study aims to investigate the potential benefit of LVA modification in older AF patients. METHODS: This study constitutes a sub-analysis of the STABLE-SR-II and STABLE-SR-III trials, wherein patients with persistent AF (PeAF) or paroxysmal AF (PAF) were randomized to undergo either circumferential pulmonary vein isolation (CPVI) alone or additional LVA modification. Patients aged ≥65 years were analyzed. The primary outcome was freedom from atrial tachyarrhythmias (ATAs). RESULTS: A total of 510 patients (mean age 70.2 ± 3.8 years, 264 male) were analyzed, comprising 96 PeAF and 414 PAF patients. Among patients without LVA, the risk of ATAs recurrence was similar between PeAF and PAF patients in the propensity score-matched model (adjusted HR, 1.49 [0.54-4.33]; p = 0.431). Both PeAF (adjusted HR, 0.35 [95% CI, 0.12-0.98]; p = 0.048) and PAF patients (adjusted HR, 0.41 [0.19-0.81]; p = 0.013) could benefit from additional LVA modification in the Cox proportional hazards model. CONCLUSIONS: In older patients with AF, the recurrence rate following CPVI alone is comparable between those with PAF and PeAF in the absence of LVA. However, the presence of LVA is associated with higher recurrence rates in both PAF and PeAF patients, while additional LVA modification effectively reduces recurrence irrespective of AF type.
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Chen et al. (2025) conducted an RCT in Atrial Fibrillation (n=510). Additional low voltage area (LVA) modification vs. Circumferential pulmonary vein isolation (CPVI) alone was evaluated on Freedom from atrial tachyarrhythmias (ATAs) (HR 0.41, 95% CI 0.19-0.81, p=0.013). Additional low voltage area modification significantly reduced the risk of atrial tachyarrhythmia recurrence compared to CPVI alone in older patients with paroxysmal (HR 0.41; 95% CI 0.19-0.81) and persistent AF (HR 0.35; 95% CI 0.12-0.98).
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