Background:The randomized controlled VOLCANO trial demonstrated comparable 1-year rhythm outcomes between patients with and without ablation targeting low-voltage areas (LVAs) in addition to pulmonary vein isolation among paroxysmal atrial fibrillation (PAF) patients with LVAs

Methods and Results:An extended-follow-up study of 402 patients enrolled in the VOLCANO trial with PAF, divided into 4 groups based on the results of voltage mapping: group A, no LVA (n=336); group B, LVA ablation (n=30); group C, LVA without ablation (n=32); and group D, incomplete voltage map (n=4). At 25 (23, 31) months after the initial ablation, AF/atrial tachycardia (AT) recurrence rates were 19% in group A, 57% in group B, 59% in group C, and 100% in group D. Recurrence rates were higher in patients with LVAs than in those without (group A vs. B+C, P<0.0001), and were comparable between those with and without LVA ablation (group B vs. C, P=0.83). Among patients who underwent repeat ablation, ATs were more frequently observed in patients with LVAs (Group B+C, 50% vs. A, 14%, P<0.0001). In addition, LVA ablation increased the incidence of AT development (group B, 71% vs. C, 32%, P<0.0001).

Conclusions:Patients with LVAs demonstrated poor long-term rhythm outcomes irrespective of LVA ablation. ATs were frequently observed in patients with LVAs, and LVA ablation might exacerbate the occurrence of iatrogenic ATs.

背景：随机对照 VOLCANO 试验表明，在伴有 LVA 的阵发性心房颤动 (PAF) 患者中，除了肺静脉隔离外，针对低电压区 (LVA) 进行消融和未消融的患者之间的 1 年节律结果相当

方法和结果：一项对 402 名参加 VOLCANO 试验的 PAF 患者的扩展随访研究，根据电压映射结果分为 4 组：A 组，无 LVA（n=336）；B组，LVA消融（n=30）；C组，未消融的LVA（n = 32）；D组，不完整的电压图（n = 4）。在初始消融后 25（23、31）个月，AF/房性心动过速（AT）复发率在 A 组为 19%，在 B 组为 57%，在 C 组为 59%，在 D 组为 100%。 复发率有 LVA 的患者比没有 LVA 的患者更高（A 组 vs. B+C，P<0.0001），并且在有和没有 LVA 消融的患者之间具有可比性（B 组 vs. C，P=0.83）。在接受重复消融的患者中，ATs 更常见于 LVA 患者（B+C 组，50% vs. A，14%，P<0.0001）。此外，

结论：无论 LVA 消融如何，LVA 患者的长期节律结果都很差。LVA 患者中经常观察到 ATs，而 LVA 消融可能会加剧医源性 ATs 的发生。