4.2 Limitations
Our study was limited by its execution as a retrospective study of a
relatively small group of patients. In addition, patient characteristics
that might have influenced the study results were not controlled for.
Nonetheless, we meticulously evaluated the factors potentially
supporting our hypothesis that LVZs on the anterior LA wall develop as a
result of a deviated aorta and increased LA pressure. Another limitation
is that intracardiac cardioversion was performed in patients who were in
AF rhythm before voltage mapping, and LA voltage measured immediately
after defibrillation might not be accurate. Further, especially in the
patients with persistent AF, the voltage maps obtained during sinus
rhythm might not have corresponded precisely to the anatomy depicted by
CT performed during AF because of the difference in rhythm and the time
between CT study and ablation.