Arrhythmias & electrophysiology
Adjunctive Low-Voltage Area Ablation Reduces Atrial Fibrillation Recurrence in Persistent Atrial Fibrillation: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis
Pooled result · Recurrent AF/atrial tachyarrhythmiaResult — go to the resultHazard ratio 0.67 95% CI 0.50–0.88Authors' conclusion
Among patients with persistent AF, adjunctive LVAA in addition to PVI significantly reduces recurrent atrial tachyarrhythmia compared with PVI alone. These findings support electroanatomically guided substrate modification as a promising individualized ablation strategy in persistent AF.
Study context
- Population
- Patients with persistent atrial fibrillation (AF)Seven randomized controlled trials (RCTs), weighted mean age 68 years, 60% male
- Participants
- 1,487 patients
- Comparison
- Low-voltage area ablation (LVAA) in addition to pulmonary vein isolation compared with pulmonary vein isolation (PVI) alone
- Outcome
- Recurrent AF/atrial tachyarrhythmia
- Follow-up
- ≥12 months after index ablation
Methodological detailsrandom-effects models, trial sequential analysis
- Random-effects models
- Trial sequential analysis
Pooled result
As reported in the abstract
Hazard ratio
0.67
95% CI 0.50–0.88
P = 0.004
PVI + LVAAvs PVI alone
HR 0.67 (95% CI 0.50–0.88); P = 0.004
Further pooled results
| Outcome | Mean difference (minutes) (95% CI) | P value | |
|---|---|---|---|
| Total procedure durationIncreased with adjunctive LVAA | 30.5 (5.8–55.2) | P = 0.02 | |
| Radiofrequency ablation durationIncreased with adjunctive LVAA | 12.3 (5.4–19.1) | P < 0.001 | |
| −50050100Difference, minutes (linear scale) |
Fluoroscopy time
- No increase in fluoroscopy time
Safety
| Outcome | Relative risk (95% CI) | P value | |
|---|---|---|---|
| Major periprocedural complications | 1.12 (0.60–2.10) | P = 0.7 | |
| 0.512Relative risk (log scale) |
Original publication
Adjunctive Low-Voltage Area Ablation Reduces Atrial Fibrillation Recurrence in Persistent Atrial Fibrillation: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis. JACC Clin Electrophysiol. Published 26 September 2026. doi:10.
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