Extensive left atrial low-voltage area during initial ablation is
associated with a poor clinical outcome even following multiple
Introduction Some patients fail to respond to persistent atrial
fibrillation (PeAF) catheter ablation in spite of multiple procedures
and ablation strategies, including low voltage area (LVA)-guided,
linear, and complex fractionated atrial electrogram (CFAE)-guided
ablation procedures. We hypothesized that LVA extent could predict
non-response to PeAF catheter ablation in spite of multiple procedures.
Methods This study included 510 patients undergoing initial ablation
procedures for PeAF. LVAs were defined as regions with bipolar
peak-to-peak voltages of <0.50 mV after PVI during sinus
rhythm. Patients were categorized by LVA size into groups A (0-5 cm2), B
(5-20 cm2), and C (over 20 cm2). The primary endpoint was AF-free
survival after the last procedure. Results During a median follow-up of
25 (17, 36) months, AF recurrence was observed in 101 (20%) patients
after 1.4±0.6 ablation procedures (maximum 4). A Kaplan-Meier analysis
showed the AF-free survival rate significantly differed by LVA size.
Conclusion Extensive LVA after initial PVI was associated with a poor
clinical outcome even following multiple procedures.