Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2023 Nov;9(11):2291-2299.
doi: 10.1016/j.jacep.2023.08.002. Epub 2023 Sep 13.

Impact of Posterior Left Atrial Voltage on Ablation Outcomes in Persistent Atrial Fibrillation: CAPLA Substudy

David Chieng  1 , Hariharan Sugumar  1 , Andrew Hunt  2 , Liang-Han Ling  1 , Louise Segan  1 , Ahmed Al-Kaisey  3 , Joshua Hawson  3 , Sandeep Prabhu  4 , Aleksandr Voskoboinik  1 , Geoffrey Wong  3 , Joseph B Morton  3 , Geoffrey Lee  3 , Matthew Ginks  5 , Laurence Sterns  6 , Prashanthan Sanders  7 , Jonathan M Kalman  8 , Peter M Kistler  9
Affiliations
Free article
Randomized Controlled Trial

Impact of Posterior Left Atrial Voltage on Ablation Outcomes in Persistent Atrial Fibrillation: CAPLA Substudy

David Chieng et al. JACC Clin Electrophysiol. 2023 Nov.
Free article

Abstract

Background: Pulmonary vein isolation (PVI) is less effective in patients with persistent atrial fibrillation (PsAF). Adjunctive ablation targeting low voltage areas (LVAs) may improve arrhythmia outcomes.

Objectives: This study aims to compare the outcomes of adding posterior wall isolation (PWI) to PVI, vs PVI alone in PsAF patients with posterior wall LVAs.

Methods: The CAPLA (Effect of Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation) study was a multicenter, randomized trial involving PsAF patients randomized 1:1 to either PVI alone or PVI with PWI. Voltage mapping performed during pacing pre-ablation was reviewed offline, with LVA defined as bipolar voltage of <0.5 mV. The primary endpoint was freedom from any documented atrial arrhythmia of >30 seconds off antiarrhythmic medication at 12 months after a single ablation procedure in patients with posterior LVA.

Results: A total of 210 patients (average 64.6 ± 9.2 years,73.3% males, median atrial fibrillation duration 4.5 months [IQR: 2 to 8 months]) underwent multipolar left atrial mapping during coronary sinus pacing with posterior LVA present in 69 (32.9%). Patients with posterior LVA were more likely to have LVA in other atrial regions (91.7% vs 57.1%; P < 0.01), larger left atrial diameter (4.8 cm vs 4.4 cm; P < 0.01), and significantly increased risk of atrial arrhythmia recurrence at 12 months (LVA: 56.5% vs no LVA: 41.4%; HR: 1.51; 95% CI: 1.01-2.27; P = 0.04) compared to no posterior LVA. However, the addition of PWI to PVI did not significantly improve freedom from atrial arrhythmia recurrence over PVI alone (PVI with PWI: 44.8% vs PVI: 41.9%; HR: 0.95; 95% CI: 0.51-1.79; P = 0.95).

Conclusions: In patients with PsAF undergoing catheter ablation, posterior LVA was associated with a significant increase in atrial arrhythmia recurrence. However, the addition of PWI in those with posterior LVA did not reduce atrial arrhythmia recurrence over PVI alone.

Keywords: atrial fibrillation; catheter ablation; low voltage area; posterior wall isolation; pulmonary vein isolation.

PubMed Disclaimer

Conflict of interest statement

Funding and Author Disclosures This study received seed grant funding from the Baker department of Cardiometabolic Health, University of Melbourne. Dr Lee has received consulting fees from Biosense Webster. Dr Sanders has served on advisory boards for Medtronic, Abbott Medical, Boston Scientific, CathRx, and PaceMate; and has received funding for research and consultancy from Medtronic, Abbott Medical, Boston Scientific, and Microport. Dr Kalman has received fellowship support from Medtronic and Biosense Webster. Dr Kistler has received the investigator grant from the NHMRC; has received funding from Abbott Medical for consultancy and speaking engagements; and has served on the advisory board with fellowship support from Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

Publication types

LinkOut - more resources