Arrhythmias & electrophysiologyMeta-analysis
Adjunctive Low-Voltage Area Ablation Reduces Atrial Fibrillation Recurrence in Persistent Atrial Fibrillation
- meta-analysis
- random-effects models
- trial sequential analysis
Authors' 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
Pooled result
As reported in the abstract
Hazard ratio
0.67
95% CI 0.50–0.88
P = 0.004
PVI + LVAA vs 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 duration · increased with adjunctive LVAA | 30.5 (5.8–55.2) | P = 0.02 | |
| Radiofrequency ablation duration · increased 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. JACC Clin Electrophysiol. Published 26 September 2026. doi:10.1016/j.jacep.2026.08.023
Summarised from the published abstract; every number is checked against it