Limitations
Several limitations of this study warrant mention. First, the definition
of low-voltage areas (areas with a voltage < 0.5 mV covering
5.0 cm2 of the left atrial surface) was somewhat
arbitrary. Second, some patients in group A and C underwent LVA
ablation, because there was no protocol strategy for repeat ablation.
Third, AF recurrence after discharge was quantified on the basis of
patient symptoms, giving rise to the possibility that asymptomatic
episodes of AF might have been missed. Fourth, some patients died or
were lost to follow-up before end of the 2-year follow-up period after
initial ablation. Finally, the small sample size might have biased the
patient characteristics and limited the statistical accuracy of our
results. Multicenter randomized controlled trials in sufficient numbers
of patients are warranted.