Discussion
This observational study followed up patients enrolled in the randomized controlled VOLCANO trial. Four main findings were recognized: (1) Patients with LVAs at the initial ablation experienced more frequent long-term (> 2 years) AF/AT recurrence and loss of sinus rhythm on final follow-up ECG than those without; (2) an ablation strategy targeting LVA failed to show a beneficial impact on long-term AF/AT recurrence after single and multiple ablations; (3) spontaneously developed or pacing-induced regular ATs were more often observed in patients with LVAs than in those without; and (4) LVA ablation increased AT development at repeat ablation, especially biatrial tachycardia after anterior-septal LVA ablation.