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Extensive left atrial low-voltage area during initial ablation is associated with a poor clinical outcome even following multiple procedures.
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  • Takashi Kanda,
  • Masaharu Masuda,
  • Mitsutoshi Asai,
  • Osamu Iida,
  • Shin Okamoto,
  • Takayuki Ishihara,
  • Kiyonori Nanto,
  • Takuya Tsujimura,
  • Yasuhiro Matsuda,
  • Yosuke Hata,
  • Hiroyuki Uematsu,
  • Toshiaki Mano
Takashi Kanda
Kansai Rosai Hospital

Corresponding Author:kanda-takashi@kansaih.johas.go.jp

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Masaharu Masuda
Kansai Rosai Hospital
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Mitsutoshi Asai
Kansai Rosai Hospital
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Osamu Iida
Kansai Rosai Hospital
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Shin Okamoto
Kansai Rosai Hospital
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Takayuki Ishihara
Kansai Rosai Hospital
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Kiyonori Nanto
Kansai Rosai Hospital
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Takuya Tsujimura
Kansai Rosai Hospital
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Yasuhiro Matsuda
Kansai Rosai Hospital
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Yosuke Hata
Kansai Rosai Hospital
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Hiroyuki Uematsu
Kansai Rosai Hospital
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Toshiaki Mano
Kansai Rosai Hospital
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Abstract

Introduction Some patients fail to respond to persistent atrial fibrillation (PeAF) catheter ablation in spite of multiple procedures and ablation strategies, including low voltage area (LVA)-guided, linear, and complex fractionated atrial electrogram (CFAE)-guided ablation procedures. We hypothesized that LVA extent could predict non-response to PeAF catheter ablation in spite of multiple procedures. Methods This study included 510 patients undergoing initial ablation procedures for PeAF. LVAs were defined as regions with bipolar peak-to-peak voltages of <0.50 mV after PVI during sinus rhythm. Patients were categorized by LVA size into groups A (0-5 cm2), B (5-20 cm2), and C (over 20 cm2). The primary endpoint was AF-free survival after the last procedure. Results During a median follow-up of 25 (17, 36) months, AF recurrence was observed in 101 (20%) patients after 1.4±0.6 ablation procedures (maximum 4). A Kaplan-Meier analysis showed the AF-free survival rate significantly differed by LVA size. Conclusion Extensive LVA after initial PVI was associated with a poor clinical outcome even following multiple procedures.