Table 1: Details of studies employing voltage guided ablation
Study Type Cohort Mapping Rhythm Mapping Catheter Voltage Threshold Control Intervention Outcome (freedom from AF) Favor LVA
Rolf et al., 2014 (18) Observational PAF/PsAF SR Multipolar + Ablation <0.5mV PVI PVI + LVA ablation 27% vs. 70%, p < 0.001 Yes
Wang et al., 2014 (24) Randomized LSPAF SR Ablation <0.5mV PVI + Linear +/- CFAE PVI + LVA ablation 45% vs. 65.5%, p = 0.04 Yes
Cutler et al., 2016 (19) Observational PsAF SR Ablation <0.5mV PVI +/- PWI (operator discretion) PVI + LVA guided PWI 57% vs. 80 %, p =0.005 Yes
Jadidi et al., 2016 (21) Observational PsAF AF Multipolar <0.5mV PVI PVI + LVA ablation targeting abnormal EGMs 47% vs. 69%, p - 0.001 Yes
Kottkamp et al., 2016 (163) Observational PAF/PsAF SR Ablation <0.5mV PVI PVI + BIFA 69.2 vs. 72.2%, p = .742 No
Yamaguchi et al., 2016 (164) Observational PsAF SR Multipolar + Ablation <0.5mV PVI PVI + LVA ablation 79% vs. 72%, p – 0.40 No
Yang et al., 2016 (23) Observational PsAF SR Multipolar LVZ 01-0.4mV, TZ 0.4-1.3mV PVI + Linear +/- CFAE PVI + LVA ablation + TZ CFAE ablation 51.3% vs. 69.8%, p = 0.011 Yes
Yagishita et al., 2016 (88) Observational PsAF AF Multipolar <0.5mV PVI (No LVA) PVI + LVA ablation 71% vs. 72%, p = 0.746 Yes
Yang et al., 2017 (27) Randomized PsAF/LSPAF SR Multipolar LVZ 01-0.4mV, TZ 0.4-1.3mV PVI + CTI + Linear +/- CFAE PVI + CTI + LVA ablation + TZ CFAE ablation 71.5% vs. 74%, p = 0.325 No
Mohanty et al., 2017 (165) Observational PAF SR Ablation <0.5mV PVI PVI + LVA ablation 18% vs. 21%, P >0.05 No
Schreiber et al., 2017 (166) Observational PAF/PsAF SR Ablation <0.5mV Nil PVI + BIFA 68.80% NA
Kircher et al., 2018 (25) Randomized PAF/PsAF SR Multipolar <0.5mV PVI +/- Linear ablation PVI + LVA ablation 42% vs. 68%, p = 0.003 Yes
Yamaguchi et al., 2018 (167) Observational PsAF SR Multipolar <0.5mV PVI (No LVA) PVI + LVA ablation 76% vs. 74% vs. 57% vs. 28% Yes*
Zhou et al., 2018 (92) Randomized PAF SR Multipolar <0.4mV PVI PVI + BIFA 52% vs. 77%, P<0.01 Yes
Ahmed-Jushuf et al., 2019 (80) Observational PsAF CSP Multipolar <0.5mV PVI PVI + LVA ablation (at operator discretion) 41% vs. 16%, p = 0.19 No
Kumagai et al., 2019 (168) Observational PsAF SR Multipolar <0.5mV PVI PVI + LVA DF Ablation 64.9% vs. 83.1%, p =0.21 Yes
Kumagai et al., 2019 (28) Randomized PsAF/LSPAF SR Multipolar <0.5mV PVI + BOXI PVI + BOXI + LVA Ablation 62% vs/ 67%, p = 0722 No
Efremidis et al., 2019 (169) Observational PsAF AF Multipolar <0.4mV NA PVI + LVA ablation targeting abnormal EGMs 40% AF termination during ablation of LVAs NA
Masuda et al., 2020 (29) Randomized PAF SR Multipolar <0.5mV PVI PVI + LVA ablation 53% vs. 57%, p = 0.67 No
Hwang et al., 2021 (136) Randomized PsAF/LSPAF AF Multipolar <0.5mV PVI PVI + LVA ablation targeting CFAEs AF: 44% vs. 84% p = 006, AF/AT: 40 vs. 60%, p= 0.329 No
Huo et al., 2022 (26) Randomized PsAF SR Multipolar <0.5mV PVI PVI + LVA ablation 50% vs 65%, p = 0.006 Yes
LVA – Low voltage ablation; PAF – paroxysmal atrial fibrillation; PsAF – persistent atrial fibrillation; LSPAF – long-standing persistent atrial fibrillation; SR – sinus rhythm; AF – atrial fibrillation; AT – atrial tachycardia; PVI – pulmonary vein isolation; CFAE – complex fractionated atrial electrogram; PWI – posterior wall isolation; LVZ – low voltage zone; TZ – transitional zone; LVZ – low voltage zone; BOXI – box isolation; BIFA – box isolation of fibrotic area; DF – dominant frequency; EGM – electrogram * - unless high burden of LVZ LVA – Low voltage ablation; PAF – paroxysmal atrial fibrillation; PsAF – persistent atrial fibrillation; LSPAF – long-standing persistent atrial fibrillation; SR – sinus rhythm; AF – atrial fibrillation; AT – atrial tachycardia; PVI – pulmonary vein isolation; CFAE – complex fractionated atrial electrogram; PWI – posterior wall isolation; LVZ – low voltage zone; TZ – transitional zone; LVZ – low voltage zone; BOXI – box isolation; BIFA – box isolation of fibrotic area; DF – dominant frequency; EGM – electrogram * - unless high burden of LVZ LVA – Low voltage ablation; PAF – paroxysmal atrial fibrillation; PsAF – persistent atrial fibrillation; LSPAF – long-standing persistent atrial fibrillation; SR – sinus rhythm; AF – atrial fibrillation; AT – atrial tachycardia; PVI – pulmonary vein isolation; CFAE – complex fractionated atrial electrogram; PWI – posterior wall isolation; LVZ – low voltage zone; TZ – transitional zone; LVZ – low voltage zone; BOXI – box isolation; BIFA – box isolation of fibrotic area; DF – dominant frequency; EGM – electrogram * - unless high burden of LVZ LVA – Low voltage ablation; PAF – paroxysmal atrial fibrillation; PsAF – persistent atrial fibrillation; LSPAF – long-standing persistent atrial fibrillation; SR – sinus rhythm; AF – atrial fibrillation; AT – atrial tachycardia; PVI – pulmonary vein isolation; CFAE – complex fractionated atrial electrogram; PWI – posterior wall isolation; LVZ – low voltage zone; TZ – transitional zone; LVZ – low voltage zone; BOXI – box isolation; BIFA – box isolation of fibrotic area; DF – dominant frequency; EGM – electrogram * - unless high burden of LVZ LVA – Low voltage ablation; PAF – paroxysmal atrial fibrillation; PsAF – persistent atrial fibrillation; LSPAF – long-standing persistent atrial fibrillation; SR – sinus rhythm; AF – atrial fibrillation; AT – atrial tachycardia; PVI – pulmonary vein isolation; CFAE – complex fractionated atrial electrogram; PWI – posterior wall isolation; LVZ – low voltage zone; TZ – transitional zone; LVZ – low voltage zone; BOXI – box isolation; BIFA – box isolation of fibrotic area; DF – dominant frequency; EGM – electrogram * - unless high burden of LVZ LVA – Low voltage ablation; PAF – paroxysmal atrial fibrillation; PsAF – persistent atrial fibrillation; LSPAF – long-standing persistent atrial fibrillation; SR – sinus rhythm; AF – atrial fibrillation; AT – atrial tachycardia; PVI – pulmonary vein isolation; CFAE – complex fractionated atrial electrogram; PWI – posterior wall isolation; LVZ – low voltage zone; TZ – transitional zone; LVZ – low voltage zone; BOXI – box isolation; BIFA – box isolation of fibrotic area; DF – dominant frequency; EGM – electrogram * - unless high burden of LVZ LVA – Low voltage ablation; PAF – paroxysmal atrial fibrillation; PsAF – persistent atrial fibrillation; LSPAF – long-standing persistent atrial fibrillation; SR – sinus rhythm; AF – atrial fibrillation; AT – atrial tachycardia; PVI – pulmonary vein isolation; CFAE – complex fractionated atrial electrogram; PWI – posterior wall isolation; LVZ – low voltage zone; TZ – transitional zone; LVZ – low voltage zone; BOXI – box isolation; BIFA – box isolation of fibrotic area; DF – dominant frequency; EGM – electrogram * - unless high burden of LVZ LVA – Low voltage ablation; PAF – paroxysmal atrial fibrillation; PsAF – persistent atrial fibrillation; LSPAF – long-standing persistent atrial fibrillation; SR – sinus rhythm; AF – atrial fibrillation; AT – atrial tachycardia; PVI – pulmonary vein isolation; CFAE – complex fractionated atrial electrogram; PWI – posterior wall isolation; LVZ – low voltage zone; TZ – transitional zone; LVZ – low voltage zone; BOXI – box isolation; BIFA – box isolation of fibrotic area; DF – dominant frequency; EGM – electrogram * - unless high burden of LVZ LVA – Low voltage ablation; PAF – paroxysmal atrial fibrillation; PsAF – persistent atrial fibrillation; LSPAF – long-standing persistent atrial fibrillation; SR – sinus rhythm; AF – atrial fibrillation; AT – atrial tachycardia; PVI – pulmonary vein isolation; CFAE – complex fractionated atrial electrogram; PWI – posterior wall isolation; LVZ – low voltage zone; TZ – transitional zone; LVZ – low voltage zone; BOXI – box isolation; BIFA – box isolation of fibrotic area; DF – dominant frequency; EGM – electrogram * - unless high burden of LVZ LVA – Low voltage ablation; PAF – paroxysmal atrial fibrillation; PsAF – persistent atrial fibrillation; LSPAF – long-standing persistent atrial fibrillation; SR – sinus rhythm; AF – atrial fibrillation; AT – atrial tachycardia; PVI – pulmonary vein isolation; CFAE – complex fractionated atrial electrogram; PWI – posterior wall isolation; LVZ – low voltage zone; TZ – transitional zone; LVZ – low voltage zone; BOXI – box isolation; BIFA – box isolation of fibrotic area; DF – dominant frequency; EGM – electrogram * - unless high burden of LVZ