Efficacy of Low-Voltage-Area Ablation Is Enhanced in Patients With Advanced Left Atrial Enlargement: A Subanalysis of the SUPPRESS-AF Trial

作者：Masaharu Masuda, Yasuhiro Matsuda, Hiroyuki Uematsu, Hirotaka Ooka, Satoshi Kudo, Mizuki Ochi, Toshiaki Mano, Akihiro Sunaga, Nobuaki Tanaka, Tetsuya Watanabe, Hitoshi Minamiguchi, Yasuyuki Egami, Takafumi Oka, Tomoko Minamisaka, Takashi Kanda, Masato Okada, Masato Kawasaki, Koji Tanaka, Nobuhiko Makino, Hirota Kida, Shungo Hikoso, Tomoharu Dohi, Koichi Inoue, Yohei Sotomi, Yasushi Sakata, Takuya Tsujimura, Yuki Matsuoka, Daisaku Nakatani, Katsuki Okada, Daisuke Sakamoto, Tetsuhisa Kitamura, Tomoaki Nakano, Takayuki Sekihara, Tomomi Yamada, Yuko Hirao, Kohei Iwasa, Nobutaka Masunaga, Yukinori Sinoda, Norioki Inui, Ryohei Amiya, Masato Fujiwara, Arisa Murakami, Yoshiharu Higuchi, Yasuhiro Ichibori, Naoki Mori, Yuma Hamanaka, Yumi Tsutsui, Mikiko Matsumura, Takashige Sakio, Satoshi Nakawatase, Yuki Shibuya, Shinya Minami, Koichi Ochi, Ken Koda, Masamichi Yano, Y Matsunaga, Koji Yasumoto, Kohei Ukita, Mizuki Osuga, Noriyuki Kobayashi, Ayako Sugino, Mitsutoshi Asai, Atsushi Kikuchi, Takumi Kondo, Tsutomu Kawai, Masahiro Seo, Atsushi Nakamura, Takeshi Fujita, Takuya Omoto, Yuki Kokubu, Yuto Fukuda, Tuyoshi Mishima, Tatsuhisa Ozaki, Takuya Ohashi · 发表于：Circulation Arrhythmia and Electrophysiology · 年份：2025 · DOI：10.1161/circep.125.014210 · 被引用次数：4 · 研究领域：Atrial Fibrillation Management and Outcomes、Cardiac Arrhythmias and Treatments、Cardiac pacing and defibrillation studies

BACKGROUND: In the randomized controlled SUPPRESS-AF trial (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), the efficacy of low-voltage-area (LVA) ablation was highly dependent on the degree of atrial remodeling, while the efficacy was not statistically significant in total patients. This subanalysis of the SUPPRESS-AF trial aimed to compare the efficacy of LVA ablation in patient groups classified by left atrial diameter (LAD), which is a commonly used atrial remodeling index. METHODS: The SUPPRESS-AF trial included patients with persistent AF and left atrial LVAs, and compared rhythm outcomes between patients randomized to undergo pulmonary vein isolation (PVI) followed by left atrial LVA ablation group (n=170) or PVI-alone group (n=172). In this post hoc subanalysis, patients in each of the 2 randomly allocated groups were further divided into 2 groups using a median LAD of 44 mm. RESULTS: Atrial fibrillation or atrial tachycardia recurrence–free rates did not differ between patients with LAD>44 mm and ≤44 mm (60.1% versus 53.7%; P =0.261). Among patients with a LAD>44 mm, the LVA ablation group demonstrated a higher atrial fibrillation or atrial tachycardia-recurrence–free rate than the PVI-alone group (62.5% versus 43.4%; P =0.016). In contrast, no difference in atrial fibrillation or atrial tachycardia recurrence–free rate was ...