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
|