4.2 Limitations
Our study was limited by its execution as a retrospective study of a relatively small group of patients. In addition, patient characteristics that might have influenced the study results were not controlled for. Nonetheless, we meticulously evaluated the factors potentially supporting our hypothesis that LVZs on the anterior LA wall develop as a result of a deviated aorta and increased LA pressure. Another limitation is that intracardiac cardioversion was performed in patients who were in AF rhythm before voltage mapping, and LA voltage measured immediately after defibrillation might not be accurate. Further, especially in the patients with persistent AF, the voltage maps obtained during sinus rhythm might not have corresponded precisely to the anatomy depicted by CT performed during AF because of the difference in rhythm and the time between CT study and ablation.