Trial reportJournal of the American Heart Association2026
Impact of Diabetes on the Efficacy of Low-Voltage Area Ablation for Persistent Atrial Fibrillation: A Subanalysis of the SUPPRESS-AF Trial.
Trial report in Journal of the American Heart Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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26 authors.
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Abstract
backgroundThe potential value of low-voltage area (LVA) ablation for persistent atrial fibrillation (AF) has been suggested. However, its efficacy determinants remain unclear. We investigated the impact of diabetes on the outcomes of LVA ablation in patients with persistent AF.
methodsThis post hoc subanalysis of the multicenter randomized controlled trial SUPPRESS-AF (Efficacy and Safety of Low-Voltage-Guided Ablation for Recurrence Prevention Compared With Pulmonary Vein Isolation Alone in Patients With Persistent Atrial Fibrillation) included patients with persistent AF undergoing initial ablation. Following pulmonary vein isolation (PVI), patients with LVAs were randomized to PVI+LVA-ablation or PVI alone. We compared recurrence-free survival between patients with and without diabetes. The primary end point was freedom from AF/atrial tachycardia recurrence.
resultsOf 1347 patients with persistent AF, 343 (25.5%) had left atrial LVAs. The nondiabetic group comprised 264 patients (136 and 128 in the PVI-alone and PVI+LVA-ablation arms, respectively), and the diabetic group comprised 77 patients (35 and 42 in each arm, respectively). No significant difference was observed in LVA extent between the groups. Overall recurrence rates were also similar (44% versus 42%;
conclusionsIn this exploratory post hoc analysis, LVA ablation may benefit patients without diabetes, whereas no clear benefit, and a possible signal of futility, was observed in patients with diabetes.
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