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May 7, 2026Heart Rhythm

Baseline low voltage area burden predicts ~265% higher 12-month AF recurrence risk per 1% increase.

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Why the study?

AF recurrence can occur despite durable pulmonary vein isolation and is associated with low voltage areas as a surrogate for atrial fibrosis, prompting characterization of longitudinal LVA changes and predictors of substrate progression.

What are the longitudinal changes in low voltage areas and predictors of substrate progression in adults undergoing repeat left atrial ablation for atrial fibrillation?

Population

Consecutive adults undergoing de novo LA ablation for AF who underwent repeat ablation

Comparison

LVA progression (>10% increase) vs non-progression

Design

Observational cohort study

Follow-up

12-month

Key result

Baseline low voltage area burden predicted 12-month atrial fibrillation recurrence (OR 3.65 per 1%, P=0.049), with left atrial myopathy advancing in one-third of repeat ablation patients.

Authors

KSKaran SarafMMMichael MalatyDFDavid Ferreira

Discussion

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Overview

LVA burden may flag higher AF recurrence risk after ablation; leaves open whether substrate modification alters outcomes in prospective trials.

Key Points

  • This study aimed to characterize changes in low voltage areas (LVAs) during repeat ablation procedures for atrial fibrillation and identify the predictors of substrate progression.
  • Enrolled adults undergoing de novo left atrial ablation for atrial fibrillation with a focus on repeat ablation cases.
  • Quantified LVAs, defining progression as a greater than 10% increase.
  • Measured conduction velocity and electrogram complexity, using regression analysis to assess predictors and their association with AF recurrence.
  • LVA burden was a significant predictor of 12-month atrial fibrillation recurrence, with an odds ratio of 3.65 per 1% increase at baseline (P = .049).
  • A second procedure showed a lower odds ratio of 2.54 for LVA burden at P = .012.
  • LA myopathy progressed in one-third of repeat ablation patients while retaining chamber size, highlighting regional differences in progression patterns.

Study Design

Type

Cohort

Structured PICO

What are the longitudinal changes in low voltage areas and predictors of substrate progression in adults undergoing repeat left atrial ablation for atrial fibrillation?

P
Population
Adults undergoing repeat left atrial ablation for atrial fibrillation, evaluated for longitudinal changes in low voltage areas and 12-month AF recurrence.
E
Exposure
Repeat left atrial ablation procedures with longitudinal electroanatomic mapping (quantification of low voltage areas, conduction velocity, and electrogram complexity).
O
Outcome
Longitudinal changes in low voltage areas (LVAs), with progression defined as >10% LVA increase.surrogate

Main Result

Odds Ratio: 3.65

p-value: p=0.049

Baseline conduction velocity and left atrial volume predict the progression of low voltage areas, indicating that functional electrical remodeling precedes structural fibrosis in patients with recurrent atrial fibrillation.

Cite This Study

Saraf et al. (2026) conducted a cohort in Atrial fibrillation. Low voltage area (LVA) burden was evaluated on 12-month AF recurrence (OR 3.65, p=0.049). Baseline low voltage area burden predicted 12-month atrial fibrillation recurrence (OR 3.65 per 1%, P=0.049), with left atrial myopathy advancing in one-third of repeat ablation patients.

synapsesocial.com/papers/69fc2da88b49bacb8b3481b2https://doi.org/10.1016/j.hrthm.2026.04.056
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