title: Efficacy of Left Atrial Voltage-Based Catheter Ablation of Persistent Atrial Fibrillation.
abstract: Low-voltage zones (LVZs) represent fibrotic tissue and are substrates for atrial fibrillation (AF). We hypothesized that LVZ-based substrate modification along with pulmonary vein isolation (PVI) would improve outcomes in persistent AF (PeAF) patients with LVZs, whereas PVI alone would work in patients without LVZs.
  
  
  
  Voltage mapping of the left atrium (LA) was performed during sinus rhythm in 101 PeAF patients in whom LVZ was defined as an area with bipolar electrograms <0.5 mV. Thirty-nine patients had LVZs and underwent ablation of the entire LVZ area after PVI (LVZabl group). In the remaining 62 patients without LVZs, PVI alone was performed with no further substrate modifications (PVI group). An additional group of 16 consecutive PeAF patients with LVZ did not undergo any substrate modification after PVI and were used as a comparison group (LVZnon-abl group) despite having similar size of LVZs to that in the LVZabl group. After a single session, 28 (72%) patients in the LVZabl group had no recurrence, whereas 49 (79%) patients in the PVI group had no recurrence during 18 ± 7 months of follow-up (log-rank, P = 0.400). In the LVZnon-abl group, only 6 patients (38%) had no recurrence during 32 ± 7 months of follow-up, even after a mean number of sessions of 1.8 (log-rank, P < 0.001, compared with the LVZabl group).
  
  
  
  Additional LVZ-based substrate modification after PVI improved the outcome in PeAF patients with LVZs, whereas PVI alone worked in patients without LVZs, even in those with PeAF.
authors.affiliation: Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan. takano-yamaguchi@nifty.com.|EP Expert Doctors-Team Tsuchiya, Kumamoto, Japan. takano-yamaguchi@nifty.com.
authors.forename: Takanori
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: EP Expert Doctors-Team Tsuchiya, Kumamoto, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsuchiya
authors.affiliation: Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakahara
authors.affiliation: EP Expert Doctors-Team Tsuchiya, Kumamoto, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Fukui
authors.affiliation: EP Expert Doctors-Team Tsuchiya, Kumamoto, Japan.
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Nagamoto
authors.affiliation: Department of Statistics, Aichi Medical University, Nagakute, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Murotani
authors.affiliation: Department of Cardiology, Saga-ken Medical Centre Koseikan, Saga, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Eshima
authors.affiliation: Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan.
authors.forename: Naohiko
authors.initials: N
authors.lastname: Takahashi
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; catheter ablation; low-voltage zone; pulmonary vein isolation; substrate mapping; voltage mapping