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.