Ablation of Low-Voltage Areas for Persistent Atrial Fibrillation: Procedural Outcomes Using High-Density Voltage Mapping

We reviewed with interest the article by Nery et al. describing catheter ablation of low-voltage areas in the treatment of persistent atrial fibrillation. 1 Nery P.B. Alqarawi W. Nair G.M. et al. Catheter ablation of low-voltage areas for persistent atrial fibrillation: procedural outcomes using high-density voltage mapping. Can J Cardiol. 2020; 36: 1956-1964 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar The authors should be commended on this study, particularly given that the previously reported success rates for catheter ablation of persistent atrial fibrillation are 43% following a single procedure using any ablation technique. 2 Clarnette J.A. Brooks A.G. Mahajan R. et al. Outcomes of persistent and long-standing persistent atrial fibrillation ablation: a systematic review and meta-analysis. EP Europace. 2018; 20: 366-376 Crossref PubMed Scopus (62) Google Scholar In this study, the authors found that by targeting low-voltage areas in addition to performing a pulmonary vein isolation, there was an increased freedom from atrial tachycardia and atrial fibrillation from 58% to 72% at 18 months with no additional complications noted. Catheter Ablation of Low-Voltage Areas for Persistent Atrial Fibrillation: Procedural Outcomes Using High-Density Voltage MappingCanadian Journal of CardiologyVol. 36Issue 12PreviewSeveral approaches have been proposed to address the challenge of catheter ablation of persistent atrial fibrillation (AF). However, the optimal ablation strategy is unknown. We sought to evaluate the efficacy of pulmonary vein isolation (PVI) plus low-voltage area (LVA) ablation using contemporary high-density mapping to identify LVA in patients with persistent AF. Full-Text PDF Reply to Hong and Glover—Catheter Ablation of Low-Voltage Areas for Persistent Atrial Fibrillation: Procedural Outcomes Using High-Density Voltage MappingCanadian Journal of CardiologyVol. 37Issue 8PreviewWe thank Hong et al. for their interest in our work and their comments. In response to their specific points, a bipolar voltage cutoff < 0.5 mV was used to detect low-voltage areas using high-density multielectrode catheters with 1-mm electrodes and 2-mm electrode spacing. The majority (8 of 10) of published studies in the field of catheter ablation for persistent atrial fibrillation have used the same cutoff. We acknowledge the need for histologic correlation; however, this approach is based on best currently available data. Full-Text PDF