Low-voltage-area ablation for persistent atrial fibrillation: a randomized controlled trial.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Low-voltage areas (LVAs) in the left atrium are implicated in promoting atrial fibrillation (AF).
• The effectiveness of ablating these LVAs to prevent arrhythmia recurrence remains uncertain.

Purpose of the Study:

• To investigate the efficacy of LVA ablation in patients with persistent AF and identified left atrial LVAs.
• To compare the recurrence rates of AF or atrial tachycardia (AT) between patients undergoing pulmonary vein isolation plus LVA ablation (PVI+LVA-ABL) and those undergoing PVI alone.

Main Methods:

• A multicenter, randomized controlled trial (SUPPRESS-AF) was conducted.
• Patients with persistent AF and LVAs covering ≥5 cm² were randomized to PVI+LVA-ABL or PVI-alone.
• Recurrence was monitored via Holter ECG and portable ECG recordings over 1 year.

Main Results:

• The PVI+LVA-ABL group showed a numerically higher rate of freedom from AF/AT recurrence (61%) compared to the PVI-alone group (50%), but this difference was not statistically significant (P=0.127).
• Procedure-related serious adverse events were similar between the groups (1.7% vs 1.8%).

Conclusions:

• LVA ablation added to PVI did not significantly reduce 1-year AF or AT recurrence in patients with persistent AF and left atrial LVAs.
• Future studies should focus on identifying specific patient subgroups who might benefit more from LVA ablation.