Endocardial low voltage areas have a significantly reduced success rate after ablation of persistent atrial fibrillation: a prospective randomized trial

Background

Pulmonary vein isolation remain unsatisfactory for the treatment of persistent atrial fibrillation. Targeting areas of low voltage represents an individual approach of substrate modification.

This prospective, randomized study investigated the efficacy of ablation of areas of LVA versus PVI alone.

Methods and results

A total number of 257 patients undergoing de-novo catheter ablation for persistent AF were randomized to three treatment arms. Patients without LVA in SR were treated with PVI only. Patients with present LVAs were randomized to PVI only or PVI + ablation of LVAs.

162 (63%) patients did not show LVAs. 48 patients with LVAs were randomized into the PVI only group and 47 patients in the PVI+LVA.

During a mean follow-up of 30 ± 6.5 months after a single procedure, 132 (81.48%) without LVAs, 27 (56%) with LVAs and PVI only and 28 (60%) with LVAs and PVI+LVA ablation did not show recurrence of any atrial arrhythmia.

Conclusions

Endocardial low voltage areas have a significant impact on the ablation of persistent atrial fibrillation. Recurrence rate is significantly higher in patients with LVAs. Ablation of LVAs does not have an impact on the recurrence rate. Therefore, PVI only as first ablation strategy seems to be appropriate.Kaplan-Meier survival curveRecurrence rate