What does this research mean for the field?

In patients with persistent atrial fibrillation, adjunctive low-voltage area ablation results in more frequent post-protocol atrial tachycardia inducibility compared to pulmonary vein isolation alone, and this inducibility is associated with increased clinical atrial tachycardia recurrence. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate whether adjunctive low-voltage area ablation increases post-procedural atrial tachycardia inducibility and whether inducibility correlates with clinical recurrence.

September 1, 2026Heart Rhythm O2Open Access

Adjunctive LVA ablation increases post-protocol AT inducibility by ~167% vs PVI alone in persistent AF.

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Persistent atrial fibrillation with low-voltage areas ≥5 cm2 (n=341). Intervention: Pulmonary vein isolation plus low-voltage area ablation (PVI+LVA-ABL) vs. Pulmonary vein isolation (PVI) alone. Primary outcome: Post-protocol atrial tachycardia (AT) inducibility (p=0.005).

View Full Paper

Ask AI

Bookmark

Why the study?

Low-voltage area ablation may facilitate atrial tachycardia, making it hard to differentiate substrate effects from ablation effects, and its link to inducibility and recurrence was unclear.

Does adjunctive LVA ablation increase post-protocol AT inducibility compared to PVI alone in patients with persistent atrial fibrillation?

Population

341 patients with persistent atrial fibrillation with LVAs ≥5 cm 2

Comparison

PVI alone vs PVI plus LVA ablation

Design

Post hoc analysis of a randomized trial

Follow-up

1-year

Key result

In patients with persistent atrial fibrillation, adjunctive low-voltage area ablation resulted in more frequent post-protocol atrial tachycardia inducibility than PVI alone (16% vs 6%, P=0.005).

Authors

KIKohei Iwasa MOMasato Okada NTNobuaki Tanaka

Discussion

Member takes

Overview

Adjunctive low-voltage area ablation was associated with higher post-protocol AT inducibility in persistent AF; hypothesis-generating and requires randomized confirmation before practice change.

Key Points

To evaluate whether adjunctive low-voltage area ablation increases post-procedural atrial tachycardia inducibility and whether inducibility correlates with clinical recurrence.
Post hoc analysis of 341 patients with persistent atrial fibrillation and low-voltage areas (≥5 cm²) enrolled in the randomized SUPPRESS-AF trial comparing pulmonary vein isolation alone versus pulmonary vein isolation plus low-voltage area ablation.
Atrial burst pacing was administered post-ablation to assess atrial tachycardia inducibility, with patients followed over 1 year to record clinical recurrence.
Post-protocol atrial tachycardia was inducible in 11% of patients overall (38/341), occurring at a significantly higher rate after pulmonary vein isolation plus low-voltage area ablation compared with pulmonary vein isolation alone (16% vs 6%, P=0.005).
During 1-year follow-up, 35 patients developed clinical recurrence, and post-protocol inducibility was independently associated with recurrence in multivariable competing-risk analysis (subdistribution HR 2.23, 95% CI 1.02–4.91).

Study Design

Type

RCT (n=341)

Structured PICO

Does adjunctive LVA ablation increase post-protocol AT inducibility compared to PVI alone in patients with persistent atrial fibrillation?

Population

341 patients with persistent atrial fibrillation and low-voltage areas ≥5 cm2, followed for 1 year.

Intervention

Pulmonary vein isolation (PVI) plus low-voltage area (LVA) ablation

Comparator

Pulmonary vein isolation (PVI) alone

Outcome

Post-protocol atrial tachycardia (AT) inducibility assessed by atrial burst pacingsurrogate

Main Result

Absolute Event Rate: 16% vs 6%

p-value: p=0.005

Adjunctive low-voltage area ablation in persistent AF increases the risk of induced atrial tachycardia, which is associated with higher clinical AT recurrence.

Cite This Study

Iwasa et al. (2026) conducted an RCT in Persistent atrial fibrillation with low-voltage areas ≥5 cm2 (n=341). Pulmonary vein isolation plus low-voltage area ablation (PVI+LVA-ABL) vs. Pulmonary vein isolation (PVI) alone was evaluated on Post-protocol atrial tachycardia (AT) inducibility (p=0.005). In patients with persistent atrial fibrillation, adjunctive low-voltage area ablation resulted in more frequent post-protocol atrial tachycardia inducibility than PVI alone (16% vs 6%, P=0.005).

synapsesocial.com/papers/6aa75661470ee4088a46d4a8 https://doi.org/10.1016/j.hroo.2026.08.146

View Full Paper

Ask AI

Bookmark

September 1, 2026Heart Rhythm O2Open Access

Adjunctive LVA ablation increases post-protocol AT inducibility by ~167% vs PVI alone in persistent AF.

View Full Paper

Ask AI

Bookmark

Why the study?

Low-voltage area ablation may facilitate atrial tachycardia, making it hard to differentiate substrate effects from ablation effects, and its link to inducibility and recurrence was unclear.

Does adjunctive LVA ablation increase post-protocol AT inducibility compared to PVI alone in patients with persistent atrial fibrillation?

Population

341 patients with persistent atrial fibrillation with LVAs ≥5 cm 2

Comparison

PVI alone vs PVI plus LVA ablation

Design

Post hoc analysis of a randomized trial

Follow-up

1-year

Key result

In patients with persistent atrial fibrillation, adjunctive low-voltage area ablation resulted in more frequent post-protocol atrial tachycardia inducibility than PVI alone (16% vs 6%, P=0.005).

Authors

KIKohei Iwasa MOMasato Okada NTNobuaki Tanaka

Discussion

Member takes

Overview

Adjunctive low-voltage area ablation was associated with higher post-protocol AT inducibility in persistent AF; hypothesis-generating and requires randomized confirmation before practice change.

Key Points

To evaluate whether adjunctive low-voltage area ablation increases post-procedural atrial tachycardia inducibility and whether inducibility correlates with clinical recurrence.
Post hoc analysis of 341 patients with persistent atrial fibrillation and low-voltage areas (≥5 cm²) enrolled in the randomized SUPPRESS-AF trial comparing pulmonary vein isolation alone versus pulmonary vein isolation plus low-voltage area ablation.
Atrial burst pacing was administered post-ablation to assess atrial tachycardia inducibility, with patients followed over 1 year to record clinical recurrence.
Post-protocol atrial tachycardia was inducible in 11% of patients overall (38/341), occurring at a significantly higher rate after pulmonary vein isolation plus low-voltage area ablation compared with pulmonary vein isolation alone (16% vs 6%, P=0.005).
During 1-year follow-up, 35 patients developed clinical recurrence, and post-protocol inducibility was independently associated with recurrence in multivariable competing-risk analysis (subdistribution HR 2.23, 95% CI 1.02–4.91).

Study Design

Type

RCT (n=341)

Structured PICO

Does adjunctive LVA ablation increase post-protocol AT inducibility compared to PVI alone in patients with persistent atrial fibrillation?

Population

341 patients with persistent atrial fibrillation and low-voltage areas ≥5 cm2, followed for 1 year.

Intervention

Pulmonary vein isolation (PVI) plus low-voltage area (LVA) ablation

Comparator

Pulmonary vein isolation (PVI) alone

Outcome

Post-protocol atrial tachycardia (AT) inducibility assessed by atrial burst pacingsurrogate

Main Result

Absolute Event Rate: 16% vs 6%

p-value: p=0.005

Adjunctive low-voltage area ablation in persistent AF increases the risk of induced atrial tachycardia, which is associated with higher clinical AT recurrence.

Cite This Study

synapsesocial.com/papers/6aa75661470ee4088a46d4a8 https://doi.org/10.1016/j.hroo.2026.08.146

View Full Paper

Ask AI

Bookmark