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Persistent atrial fibrillation without the evidence of low-voltage areas: a prospective randomized trial

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Abstract

Background

An effective therapy of persistent atrial fibrillation beyond pulmonary vein isolation remains unsatisfactory. Targeting endocardial low-voltage areas represents an approach of substrate modification. This prospective, randomized study investigated the efficacy of ablation of low-voltage areas versus PVI and additional linear ablations in patients with persistent atrial fibrillation in terms of single-procedure arrhythmia-free outcome and safety.

Methods and results

A total number of 100 patients undergoing de-novo catheter ablation for persistent AF were randomized in a 1:1 ratio into two different treatment arms: group A: pulmonary vein isolation (PVI) and, if low-voltage areas were present, a substrate modification. Group B: PVI and, if atrial fibrillation persisted, additional ablations, such as linear ablation and/or ablation of non-PV triggers. A total of 50 patients were randomized into each group without significant differences in baseline characteristics. During a mean follow-up of 17.64 ± 4.5 months after a single procedure, 34 (68%) patients of group A were free of arrhythmia recurrence versus 28 (56%) patients in group B (p = ns). In group A, 30 (60%) patients did not show endocardial fibrosis and received solely PVI. Both procedures were performed with a low number of complications; no pericardial effusion or stroke were seen in either group.

Conclusions

A significant proportion of patients with persistent atrial fibrillation do not show low-voltage areas. A total of 70% of the patients receiving solely PVI did not show any recurrence of atrial fibrillation, and therefore, extensive additional ablation should be avoided in de-novo patients.

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Authors and Affiliations

  1. Department of Cardiology, Robert-Bosch Hospital Stuttgart, Stuttgart, Germany

    Bastian Kaiser, Carola Huber, Giancarlo Pirozzolo, Pasqual Maier, Raffi Bekeredjian & Cathrin Theis

  2. Department of Internal Medicine 3, Cardiology/Electrophysiology, Robert Bosch Hospital Stuttgart, Auerbachstr. 101, 7096, Stuttgart, Germany

    Cathrin Theis

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  1. Bastian Kaiser
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Correspondence to Cathrin Theis.

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Ethical approval

This study was conducted in accordance with the Helsinki Declaration, and the prospective trial was approved by the local Ethics Committee. An informed written consent from every patient was obtained.

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The authors declare no competing interests.

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Kaiser, B., Huber, C., Pirozzolo, G. et al. Persistent atrial fibrillation without the evidence of low-voltage areas: a prospective randomized trial. J Interv Card Electrophysiol 67, 83–90 (2024). https://doi.org/10.1007/s10840-023-01564-2

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  • DOI: https://doi.org/10.1007/s10840-023-01564-2

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