Observational studyEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2023
Dynamic changes of left atrial substrate over time following pulmonary vein isolation: the Progress-AF study.
Observational study in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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11 citing papers in PubMed.
- Impact of renal function on the efficacy of low-voltage area ablation after pulmonary vein isolation: a sub-analysis of the SUPPRESS-AF trial.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Trial
- Atrial Substrate Progression in AF Patients: Insights From Unipolar Mapping.Pacing and clinical electrophysiology : PACE · 2026Article
- Left atrial epicardial adipose tissue volume quantification by CMR aids identification of patients at low risk for left atrial cardiomyopathy.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Intraprocedural Findings and Outcomes of Redo Procedures After Voltage-Guided Ablation of Persistent Atrial Fibrillation.Journal of clinical medicine · 2026Article
- Left atrial anterior scar in persistent atrial fibrillation: Results with pulmonary vein isolation and linear ablation including posterior mitral line.Heart rhythm O2 · 2026Article
- Pulsed field ablation for atrial fibrillation ablation: a European Heart Rhythm Association survey.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Article
- Impact of atrial functional substrate in patients with atrial fibrillation: The potential utility of decremental evoked potential mapping in the atrium.Heart rhythm O2 · 2025Article
- Sex-related differences in left atrial substrate among patients with atrial fibrillation: evidence from high-density voltage mapping.European journal of medical research · 2024Article
- Atrial fibrillation rhythm management: a matter of timing.European heart journal supplements : journal of the European Society of Cardiology · 2024Article
- Left atrial spatial entropy: a novel tool for electrophysiological substrate characterization in atrial fibrillation.Frontiers in physiology · 2024Article
- Unraveling the interplay: early-stage atrial functional mitral regurgitation and left atrial electrical substrate in atrial fibrillation patients.Frontiers in cardiovascular medicine · 2024Article
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11 authors.
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Abstract
aimsLittle is known about dynamic changes of the left atrial (LA) substrate over time in patients with atrial fibrillation (AF). This study aims to evaluate substrate changes following pulmonary vein isolation (PVI). METHODS AND
resultsIn our prospective observational study, consecutive patients undergoing first PVI-only and redo ablation were included. High-density maps of the two procedures were compared. Progression or regression was diagnosed if a significant concordant decrease or increase in bipolar voltages in ≥2 segments was observed, respectively. In 28 patients (61.2 ± 9.5 years, 39% female, 53.5% persistent AF), 111.013 voltage points from 56 high-density LA maps (1.982 points/patient) were analysed. Comparing the high-density maps of the first and second procedures, in the progression group (17 patients, 61%), there was a decrease in global (-35%, P < 0.001) and all regional voltages. In the regression group (11 patients, 39%), there was an increase in global (+43%, P < 0.001) and regional voltages. Comparing the progression with the regression group, the area of low-voltage zone (LVZ) increased (+3.5 vs. -4.5 cm2, P < 0.001) and LA activation time prolonged (+8.0 vs. -9.1 ms, P = 0.005). Baseline clinical parameters did not predict progression or regression. In patients with substrate progression, pulmonary veins (PVs) were more frequently isolated (P = 0.02) and the AF pattern at recurrence was more frequently persistent (P = 0.005).
conclusionOur study describes bidirectional dynamic properties of the LA substrate with concordant either progressive or regressive changes. Regression occurs with reduced AF burden after the first procedure, while progression is associated with persistent AF recurrence despite durable PV isolation. The dynamic nature of LA substrate poses questions about LVZ-based ablation strategies.
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