Efficacy of Low‐Voltage Area Ablation Across Substrate Size in Persistent Atrial Fibrillation: A Post Hoc Analysis of the SUPPRESS‐AF Randomized Trial

Journal of the American Heart Association 2026 Open access

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Authors: Masato Okada, Daisuke Sakamoto, Masaharu Masuda, Nobuaki Tanaka, Tetsuya Watanabe, Hitoshi Minamiguchi, Yasuyuki Egami, Takafumi Oka, Tomoko Minamisaka, Masato Kawasaki, Nobuhiko Makino, Takashi Kanda
+13 more Yasuhiro Matsuda, Koji Tanaka, Yuko Hirao, Naoko Miyazaki, Kohei Iwasa, Hirota Kida, Shungo Hikoso, Akihiro Sunaga, Tomoharu Dohi, Koichi Inoue, Yohei Sotomi, Y Sakata, OCVC‐Arrhythmia Investigators
DOI: 10.1161/jaha.125.047814
Cited by: 3
References: 29

Abstract

Background Larger low‐voltage areas (LVAs) in the left atrium are associated with increased arrhythmia recurrence after atrial fibrillation (AF) ablation. The benefit of adjunctive LVA ablation may therefore depend on substrate extent. This study examined the efficacy of LVA ablation across a spectrum of LVA sizes in persistent AF. Methods The SUPPRESS‐AF (Efficacy and Safety of Left Atrial Low‐Voltage Area Guided Ablation for Recurrence Prevention Compared to Pulmonary Vein Isolation Alone in Patients With Persistent Atrial Fibrillation) trial screened 1364 patients undergoing initial ablation for persistent AF, of whom 342 with left atrial LVAs (≥5 cm 2 ) were randomized to pulmonary vein isolation with or without adjunctive LVA ablation. In the 341 analyzed patients, LVA size was categorized as small (

Fields of Study & Subjects

Atrial Fibrillation Management and Outcomes Cardiac Arrhythmias and Treatments Cardiac pacing and defibrillation studies

Publication details

Journal / source
Journal of the American Heart Association
Publisher
Ovid Technologies (Wolters Kluwer Health)
Volume
15
Issue
11
Pages
e047814–e047814
Publication date
25 May 2026
Language
EN