Additional Low‐Voltage‐Area Ablation in Patients With Paroxysmal Atrial Fibrillation: Results of the Randomized Controlled VOLCANO Trial
Background The efficacy of low‐voltage‐area (LVA) ablation has not been well determined. This study aimed to investigate the efficacy of LVA ablation in addition to pulmonary vein isolation on rhythm outcomes in patients with paroxysmal atrial fibrillation (AF). Methods and Results VOLCANO (Catheter...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.015927 |
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| author | Masaharu Masuda Mitsutoshi Asai Osamu Iida Shin Okamoto Takayuki Ishihara Kiyonori Nanto Takashi Kanda Takuya Tsujimura Yasuhiro Matsuda Shota Okuno Yosuke Hata Toshiaki Mano |
| author_facet | Masaharu Masuda Mitsutoshi Asai Osamu Iida Shin Okamoto Takayuki Ishihara Kiyonori Nanto Takashi Kanda Takuya Tsujimura Yasuhiro Matsuda Shota Okuno Yosuke Hata Toshiaki Mano |
| author_sort | Masaharu Masuda |
| collection | DOAJ |
| description | Background The efficacy of low‐voltage‐area (LVA) ablation has not been well determined. This study aimed to investigate the efficacy of LVA ablation in addition to pulmonary vein isolation on rhythm outcomes in patients with paroxysmal atrial fibrillation (AF). Methods and Results VOLCANO (Catheter Ablation Targeting Low‐Voltage Areas After Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation Patients) trial included paroxysmal AF patients undergoing initial AF ablation. Of 398 patients in whom a left atrial voltage map was obtained after pulmonary vein isolation, 336 (85%) had no LVA (group A). The remaining 62 (15%) patients with LVAs were randomly allocated to undergo LVA ablation (group B, n=30) or not (group C, n=32) in a 1:1 fashion. Primary end point was 1‐year AF‐recurrence‐free survival rate. No adverse events related to LVA ablation occurred. Procedural (124±40 versus 95±33 minutes, P=0.003) and fluoroscopic times (29±11 versus 24±8 minutes, P=0.034) were longer in group B than group C. Patients with LVAs demonstrated lower AF‐recurrence‐free survival rates (88%) than those without LVA (B, 57%, P<0.0001; C, 53%, P<0.0001). However, LVA ablation in addition to pulmonary vein isolation did not impact AF‐recurrence‐free survival rate (group B versus C, P=0.67). Conclusions The presence of LVA was a strong predictor of AF recurrence after pulmonary vein isolation in patients with paroxysmal AF. However, LVA ablation had no beneficial impact on 1‐year rhythm outcomes. Registration URL: https://www.umin.ac.jp/ctr; Unique identifier: UMIN000023403. |
| first_indexed | 2024-12-13T08:56:01Z |
| format | Article |
| id | doaj.art-2ffbf190519b4656a9d1fe84714a0920 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T08:56:01Z |
| publishDate | 2020-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-2ffbf190519b4656a9d1fe84714a09202022-12-21T23:53:16ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-07-0191310.1161/JAHA.120.015927Additional Low‐Voltage‐Area Ablation in Patients With Paroxysmal Atrial Fibrillation: Results of the Randomized Controlled VOLCANO TrialMasaharu Masuda0Mitsutoshi Asai1Osamu Iida2Shin Okamoto3Takayuki Ishihara4Kiyonori Nanto5Takashi Kanda6Takuya Tsujimura7Yasuhiro Matsuda8Shota Okuno9Yosuke Hata10Toshiaki Mano11Kansai Rosai Hospital Cardiovascular Center Hyogo JapanKansai Rosai Hospital Cardiovascular Center Hyogo JapanKansai Rosai Hospital Cardiovascular Center Hyogo JapanKansai Rosai Hospital Cardiovascular Center Hyogo JapanKansai Rosai Hospital Cardiovascular Center Hyogo JapanKansai Rosai Hospital Cardiovascular Center Hyogo JapanKansai Rosai Hospital Cardiovascular Center Hyogo JapanKansai Rosai Hospital Cardiovascular Center Hyogo JapanKansai Rosai Hospital Cardiovascular Center Hyogo JapanKansai Rosai Hospital Cardiovascular Center Hyogo JapanKansai Rosai Hospital Cardiovascular Center Hyogo JapanKansai Rosai Hospital Cardiovascular Center Hyogo JapanBackground The efficacy of low‐voltage‐area (LVA) ablation has not been well determined. This study aimed to investigate the efficacy of LVA ablation in addition to pulmonary vein isolation on rhythm outcomes in patients with paroxysmal atrial fibrillation (AF). Methods and Results VOLCANO (Catheter Ablation Targeting Low‐Voltage Areas After Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation Patients) trial included paroxysmal AF patients undergoing initial AF ablation. Of 398 patients in whom a left atrial voltage map was obtained after pulmonary vein isolation, 336 (85%) had no LVA (group A). The remaining 62 (15%) patients with LVAs were randomly allocated to undergo LVA ablation (group B, n=30) or not (group C, n=32) in a 1:1 fashion. Primary end point was 1‐year AF‐recurrence‐free survival rate. No adverse events related to LVA ablation occurred. Procedural (124±40 versus 95±33 minutes, P=0.003) and fluoroscopic times (29±11 versus 24±8 minutes, P=0.034) were longer in group B than group C. Patients with LVAs demonstrated lower AF‐recurrence‐free survival rates (88%) than those without LVA (B, 57%, P<0.0001; C, 53%, P<0.0001). However, LVA ablation in addition to pulmonary vein isolation did not impact AF‐recurrence‐free survival rate (group B versus C, P=0.67). Conclusions The presence of LVA was a strong predictor of AF recurrence after pulmonary vein isolation in patients with paroxysmal AF. However, LVA ablation had no beneficial impact on 1‐year rhythm outcomes. Registration URL: https://www.umin.ac.jp/ctr; Unique identifier: UMIN000023403.https://www.ahajournals.org/doi/10.1161/JAHA.120.015927ablationatrial fibrillationlow‐voltage areaparoxysmalrecurrence |
| spellingShingle | Masaharu Masuda Mitsutoshi Asai Osamu Iida Shin Okamoto Takayuki Ishihara Kiyonori Nanto Takashi Kanda Takuya Tsujimura Yasuhiro Matsuda Shota Okuno Yosuke Hata Toshiaki Mano Additional Low‐Voltage‐Area Ablation in Patients With Paroxysmal Atrial Fibrillation: Results of the Randomized Controlled VOLCANO Trial Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease ablation atrial fibrillation low‐voltage area paroxysmal recurrence |
| title | Additional Low‐Voltage‐Area Ablation in Patients With Paroxysmal Atrial Fibrillation: Results of the Randomized Controlled VOLCANO Trial |
| title_full | Additional Low‐Voltage‐Area Ablation in Patients With Paroxysmal Atrial Fibrillation: Results of the Randomized Controlled VOLCANO Trial |
| title_fullStr | Additional Low‐Voltage‐Area Ablation in Patients With Paroxysmal Atrial Fibrillation: Results of the Randomized Controlled VOLCANO Trial |
| title_full_unstemmed | Additional Low‐Voltage‐Area Ablation in Patients With Paroxysmal Atrial Fibrillation: Results of the Randomized Controlled VOLCANO Trial |
| title_short | Additional Low‐Voltage‐Area Ablation in Patients With Paroxysmal Atrial Fibrillation: Results of the Randomized Controlled VOLCANO Trial |
| title_sort | additional low voltage area ablation in patients with paroxysmal atrial fibrillation results of the randomized controlled volcano trial |
| topic | ablation atrial fibrillation low‐voltage area paroxysmal recurrence |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.015927 |
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