Introduction
The presence of left atrial
low-voltage areas (LVAs) has been strongly associated with AF recurrence
after PVI even in patients with paroxysmal AF.1-3Several observational studies have reported the possible efficacy of
ablation targeting LVAs.1,4
VOLCANO was a randomized controlled trial that compared 1-year AF
recurrence rates between following ablation strategies: PVI alone for
patients without LVAs, PVI plus LVA ablation for those with LVAs, and
PVI alone for those with LVAs.5 Results showed that
poorer rhythm outcomes in patients with LVAs than those without. In
addition, comparable AF recurrence rates were observed between patients
with and without LVA ablation, suggesting that LVA ablation in addition
to PVI had no beneficial impact on 1-year rhythm outcomes in paroxysmal
AF patients. However, the VOLCANO trial had a relatively short follow-up
period, which limited its clinical implications.
Here, to overcome this limitation, we conducted an extended follow-up
study of the VOLCANO trial which compared rhythm outcomes over more than
2 years of follow-up, and types of recurrent-atrial-tachyarrhythmias
between the treatment cohorts.