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Review
. 2024 Aug 3;13(15):4541.
doi: 10.3390/jcm13154541.

Low-Voltage Area Ablation in Addition to Pulmonary Vein Isolation in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis

Stefano Valcher  1   2 , Alessandro Villaschi  1   3 , Giulio Falasconi  4   5   6 , Mauro Chiarito  1   4 , Filippo Giunti  1   4 , Laura Novelli  1   4 , Lucio Addeo  2   7 , Antonio Taormina  4 , Cristina Panico  1   4 , Pietro Francia  5   8 , Andrea Saglietto  5   9 , Guido Del Monaco  1   4 , Alessia Chiara Latini  1   4 , Sebastiano Carli  1   4 , Stefano Frittella  1   4 , Alessandro Giaj Levra  1   4 , Giulia Antonelli  1   4 , Alberto Preda  10 , Fabrizio Guarracini  10 , Patrizio Mazzone  10 , Antonio Berruezo  5 , Massimo Tritto  1   4 , Gianluigi Condorelli  1   4 , Diego Penela  4   5
Affiliations
Review

Low-Voltage Area Ablation in Addition to Pulmonary Vein Isolation in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis

Stefano Valcher et al. J Clin Med. .

Abstract

Background: Low-voltage area (LVA) ablation, in addition to pulmonary vein isolation (PVI), has been proposed as a new strategy in patients with atrial fibrillation (AF), but clinical trials have shown conflicting results. We performed a systematic review and meta-analysis to assess the impact of LVA ablation in patient undergoing AF ablation (PROSPERO-registered CRD42024537696). Methods: Randomized clinical trials investigating the role of LVA ablation in addition to PVI in patients with AF were searched on PubMed, Embase, and the Cochrane Library from inception to 22 April 2024. Primary outcome was atrial arrhythmia recurrence after the first AF ablation procedure. Secondary endpoints included procedure time, fluoroscopy time, and procedure-related complication rate. Sensitivity analysis including only patients with LVA demonstration at mapping and multiple subgroups analyses were also performed. Results: 1547 patients from 7 studies were included. LVA ablation in addition to PVI reduced atrial arrhythmia recurrence (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.52-0.81, p < 0.001) with a number needed to treat to prevent recurrence of 10. No difference in procedure time (mean difference [MD] -5.32 min, 95% CI -19.01-8.46 min, p = 0.45), fluoroscopy time (MD -1.10 min, 95% CI -2.48-0.28 min, p = 0.12) and complication rate (OR 0.81, 95% CI 0.40-1.61, p = 0.54) was observed. Consistent results were demonstrated when considering only patients with LVA during mapping and in prespecified subgroups for AF type (paroxysmal vs. persistent), multicentric vs. monocentric trial, and ablation strategy in control group. Conclusions: In patients with AF, ablation of LVAs in addition to PVI reduces atrial arrhythmia recurrence without a significant increase in procedure time, fluoroscopy time, or complication rate.

Keywords: atrial fibrillation; catheter ablation; low-voltage area; metanalysis; paroxysmal atrial fibrillation; persistent atrial fibrillation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow-chart.
Figure 2
Figure 2
Forest plot of atrial arrhythmia recurrence. LVA low-voltage area; OR odds ratio, CI confidence interval [15,16,17,18,19,20,23].
Figure 3
Figure 3
Forrest plot of atrial arrhythmia recurrence considering only the LVA population. LVA low-voltage areas, OR odds ratio, CI confidence interval [15,17,18,19,20,23].
Figure 4
Figure 4
Forrest plot of procedure time. LVA low-voltages area, MD mean difference, CI confidence interval, N number of patients, SD standard deviation [15,16,17,18,20,23].
Figure 5
Figure 5
Forrest plot of fluoroscopy time. LVA low-voltages area, MD mean difference, CI confidence interval, N number of patients, SD standard deviation [15,16,17,18,23].
Figure 6
Figure 6
Forrest plot of complications. LVA low-voltages area, OR odds ratio, CI confidence interval [16,17,18,19,20,23].
See this image and copyright information in PMC

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