title: Long-Term Outcome of Left Atrial Voltage-Guided Substrate Ablation During Atrial Fibrillation: A Novel Adjunctive Ablation Strategy.
abstract: Left atrium (LA) low voltage area (LVA) on 3-D electroanatomic bipolar voltage mapping (EAVM), as a surrogate for scar, is associated with poor AF ablation outcome. We evaluated the long-term outcome of an LVA-guided atrial fibrillation (AF) substrate modification strategy as an adjunct to pulmonary vein isolation (PVI).
  
  
  
  Two hundred and one consecutive patients with AF (82% persistent/Non-PAF, age 65 years), who underwent EAVM during AF prior to PVI, were divided into 2 groups according to the presence or absence of LVA outside the PV antra, defined as bipolar voltage of <0.5 mV. LVA-guided substrate modification was performed after PVI in patients with LVA. LVA was found in 159 patients (79%). Non-PAF (OR 3.851, P = 0.002) and CHA2DS2-VASc score (OR 1.815, P < 0.001) were independent predictors for the LVA. After the index procedure, 144 patients (72%) were free from AF at 12 months. With multiple procedures, 148 patients (74%) during a median follow-up of 3.1 years were free from the recurrence. There was no difference in the recurrence (log-rank P = 0.746), and complications (0% vs. 7%, P = 0.125) between the groups. Neither LVA nor Non-PAF was an independent predictor for the recurrence in a multivariate analysis.
  
  
  
  Patients with LVA had an equally favorable long-term ablation outcome compared to those without. As an adjunct to PVI, voltage-guided substrate modification may be an important ablation strategy in patients with LA structural remodeling.
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University, School of Medicine, Cleveland, Ohio, United States.
authors.forename: Atsuhiko
authors.initials: A
authors.lastname: Yagishita
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University, School of Medicine, Cleveland, Ohio, United States.
authors.forename: J Rod
authors.initials: JR
authors.lastname: Gimbel
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University, School of Medicine, Cleveland, Ohio, United States.
authors.forename: Samer
authors.initials: S
authors.lastname: DE Oliveira
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University, School of Medicine, Cleveland, Ohio, United States.
authors.forename: Harish
authors.initials: H
authors.lastname: Manyam
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University, School of Medicine, Cleveland, Ohio, United States.
authors.forename: Dina
authors.initials: D
authors.lastname: Sparano
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University, School of Medicine, Cleveland, Ohio, United States.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cakulev
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University, School of Medicine, Cleveland, Ohio, United States.
authors.forename: Judith
authors.initials: J
authors.lastname: Mackall
authors.affiliation: University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University, School of Medicine, Cleveland, Ohio, United States.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Arruda
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D064752:Atrial Remodeling; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; 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; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: atrial fibrillation; atrial remodeling; catheter ablation; electroanatomical mapping; pulmonary vein isolation