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Low-voltage-area ablation in paroxysmal atrial fibrillation: Extended follow-up results of the VOLCANO trial
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  • Masaharu Masuda,
  • Mitsutoshi Asai,
  • Osamu Iida,
  • Shin Okamoto,
  • Takayuki Ishihara,
  • Kiyonori Nanto,
  • Takashi Kanda,
  • Takuya Tsujimura,
  • Yasuhiro Matsuda,
  • Yosuke Hata,
  • Hiroyuki Uematsu,
  • Toshiaki Mano
Masaharu Masuda
Kansai Rosai Hospital
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Mitsutoshi Asai
Kansai Rosai Hospital
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Osamu Iida
Kansai Rosai Hospital
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Shin Okamoto
Kansai Rosai Hospital
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Takayuki Ishihara
Kansai Rosai Hospital
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Kiyonori Nanto
Kansai Rosai Hospital
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Takashi Kanda
Kansai Rosai Hospital
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Takuya Tsujimura
Kansai Rosai Hospital
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Yasuhiro Matsuda
Kansai Rosai Hospital
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Yosuke Hata
Kansai Rosai Hospital
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Hiroyuki Uematsu
Kansai Rosai Hospital
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Toshiaki Mano
Kansai Rosai Hospital
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Abstract

Introduction: The randomized controlled VOLCANO trial demonstrated comparable 1-year rhythm outcomes between patients with and without ablation targeting low-voltage areas (LVAs) in addition to pulmonary vein isolation among paroxysmal atrial fibrillation (AF) patients with LVAs. To compare long-term AF/atrial tachycardia (AT) recurrence rates and types of recurrent-atrial-tachyarrhythmia between treatment cohorts during a > 2-year follow-up period. Methods: An extended-follow-up study of 402 patients enrolled in the VOLCANO trial with paroxysmal AF, divided into 4 groups based on the results of voltage mapping: Group A, no LVA (n=336); group B, LVA ablation (n=30); group C, LVA presence without ablation (n=32); and group D, incomplete voltage map (n=4). Results: At 25 (23, 31) months after the initial ablation, AF/AT recurrence rates were 19% in group A, 57% in group B, 59% in group C, and 100% in group D. Recurrence rates were higher in patients with LVAs than those without (group A vs. B+C, p<0.0001), and were comparable between those with and without LVA ablation (group B vs. C, p=0.83). Among patients who underwent repeat ablation, ATs were more frequently observed in patients with LVAs (Group B+C, 50% vs. A, 14%, p<0.0001). In addition, LVA ablation increased the incidence of AT development (group B, 71% vs. C, 32%, p<0.0001), especially biatrial tachycardia (20% vs. 0%, p=0.01). Conclusion: Patients with LVAs demonstrated poor long-term rhythm outcomes irrespective of LVA ablation. ATs were frequently observed in patients with LVAs, and LVA ablation might exacerbate iatrogenic ATs.