ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2025
Ablation of slow activation areas in addition to pulmonary vein isolation improves the maintenance of the sinus rhythm in patients with persistent atrial fibrillation.
Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.
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1 citing paper in PubMed.
- Artificial intelligence-guided pulsed field ablation for persistent atrial fibrillation: automated peak frequency mapping predicts termination sites and durable rhythm control.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Article
Corrections and comments
- Erratum issued
Authors and funding
6 authors.
Funding
Abstract
backgroundSlow activation areas, characterized by decreased conduction velocities in the left atrium, are commonly observed in patients with persistent atrial fibrillation (PeAF). However, it remains unclear whether the ablation of slow activation areas combined with pulmonary vein isolation (PVI) improves clinical outcomes in these patients.
methodsThis single-center retrospective study included patients who underwent catheter ablation for PeAF. A total of 78 consecutive patients were included in the PVI + SAA group, while another 78 patients who underwent PVI with/without the roof line, matched 1:1 by propensity score, served as the control group. Slow activation area was defined as ≥ 4 10 ms-step isochrones within 10 mm distance. The endpoint was AF recurrence, atrial flutter, or atrial tachycardia (AT) lasting > 30 s after the blanking period.
resultsThe mean mapping time was 10 ± 3 min in the PVI + SAA group. Slow activation areas were identified in 37 of the 78 patients, predominantly located in the anterior wall and often overlapping with the low-voltage areas. The proportion of atrial arrhythmia-free patients was significantly higher in the PVI + SAA group compared to the PVI group (Log-rank P = 0.024; hazard ratio [HR]: 0.40; 95% confidence interval [CI]: 0.19-0.85). Subgroup analysis showed no significant difference in AT/AF recurrence rates between patients who underwent additional ablation of slow activation area and those without identified slow activation areas in the PVI + SAA group (Log-rank P = 0.73; HR: 1.20; 95% CI: 0.42-3.42).
conclusionsSlow activation areas can be efficiently identified using isochronal mapping. Targeted ablation of slow activation areas helps reduce AT/AF recurrence in patients with PeAF.
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