Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio, USA.
Division of Cardiovascular Medicine, Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio, USA.
J Cardiovasc Electrophysiol. 2023 Feb;34(2):455-464. doi: 10.1111/jce.15764. Epub 2022 Dec 9.
Low voltage areas (LVAs) on left atrial (LA) bipolar voltage mapping correlate with areas of fibrosis. LVAs guided substrate modification was hypothesized to improve the success rate of atrial fibrillation (AF) ablation particularly in nonparoxysmal AF population. However, randomized controlled trials (RCTs) and observational studies yielded mixed results.
The databases of Pubmed, EMBASE and Cochrane Central databases were searched from inception to August 2022. Relevant studies comparing LVA guided substrate modification (LVA ablation) versus conventional AF ablation (non LVA ablation) in patients with nonparoxysmal AF were identified and a meta-analysis was performed (Graphical Abstract image). The efficacy endpoints of interest were recurrence of AF and the need for repeat ablation at 1-year. The safety endpoint of interest was adverse events for both groups. Procedure related endpoints included total procedure time and fluoroscopy time.
A total of 11 studies with 1597 patients were included. A significant reduction in AF recurrence at 1-year was observed in LVA ablation versus non LVA ablation group (risk ratio [RR] 0.63 (27% vs. 36%),95% confidence interval [CI] 0.48-0.62, p < .001]. Also, redo ablation was significantly lower in LVA ablation group (RR 0.52[18% vs. 26.7%], 95% CI 0.38-0.69, p < .00133). No difference was found in the overall adverse event (RR 0.7 [4.3% vs. 5.4%], 95% CI 0.36-1.35, p = .29).
LVA guided substrate modification provides significant reduction in recurrence of all atrial arrhythmias at 1-year compared with non LVA approaches in persistent and longstanding persistent AF population without increase in adverse events.
左心房（LA）双极电压标测中的低电压区（LVAs）与纤维化区域相关。假设 LVAs 指导下的基质改良可以提高房颤（AF）消融的成功率，特别是在非阵发性 AF 人群中。然而，随机对照试验（RCTs）和观察性研究得出的结果喜忧参半。
从建库至 2022 年 8 月，检索 Pubmed、EMBASE 和 Cochrane Central 数据库。确定了比较非阵发性 AF 患者中 LVAs 指导下的基质改良（LVA 消融）与常规 AF 消融（非 LVA 消融）的相关研究，并进行了荟萃分析（图摘要图像）。感兴趣的疗效终点是 AF 复发和 1 年内需要再次消融。感兴趣的安全性终点是两组的不良事件。与手术相关的终点包括总手术时间和透视时间。
共纳入 11 项研究，共 1597 例患者。与非 LVA 消融组相比，LVA 消融组在 1 年内 AF 复发明显减少（风险比 [RR] 0.63 [27%比 36%]，95%置信区间 [CI] 0.48-0.62，p<0.001）。LVA 消融组再次消融的比例也明显降低（RR 0.52 [18%比 26.7%]，95% CI 0.38-0.69，p<0.00133）。两组总体不良事件发生率无差异（RR 0.7 [4.3%比 5.4%]，95% CI 0.36-1.35，p=0.29）。
与非 LVA 方法相比，LVA 指导下的基质改良在持续性和长期持续性 AF 人群中，1 年内可显著降低所有房性心律失常的复发率，且不良事件发生率无增加。
