Introduction
Although catheter ablation has been established as an important
treatment for atrial fibrillation (AF), the outcomes of PVI alone for
persistent AF (PeAF) are unsatisfactory. 1-3 Substrate
modification to improve outcomes has been performed, and favorable
outcomes have been reported for low voltage area (LVA)-guided, linear,
and CFAE ablation. 4,5 Nevertheless, some patients
remain as non-responders to PeAF catheter ablation in spite of multiple
procedures and various ablation strategies. The prevalence of left
atrial low-voltage areas (LVAs) is strongly associated with the
recurrence of atrial tachyarrhythmias following catheter ablation.6-11 We
considered
that LVA extent could predict non-responders to PeAF catheter ablation
in spite of multiple procedures.