Background This study aimed to evaluate the relationship between dominant frequencies (DFs)/rotors and low-voltage areas (LVAs) using the Advisor HD grid (HDG) after pulmonary vein isolation (PVI) in non-paroxysmal atrial fibrillation (AF). Methods A total of 73 non-paroxysmal AF patients were prospectively investigated. After pulmonary vein isolation (PVI), an online real-time phase mapping system was used to detect the location of rotors with critical non-passively activated ratios (%NPs) of≧50% in each LA segment, and high-DFs of ≧7Hz were simultaneously mapped. After recovering sinus rhythm, LVAs (<0.5mV) were mapped using the HDG. Results Sixty-eight of 73 (93.2%) AF patients had minimum to mild LVAs (<10%) regardless of an enlarged LAD and LA volume (45±6.1mm and 142±30ml). There were no significant differences in the max and mean DF values and %NPs between the patients with and without recurrent AF/AT (atrial tachycardia). However, LVAs were significantly greater in the patients with AF/AT than in those without (6.4±8.0% vs. 2.5±2.6% P=0.003). Furthermore, the number of high-DF sites overlapping with LVAs was significantly greater in the patients with AF/AT than in those without (0.5±0.8 vs. 0.2±0.7, P=0.019). The AF/AT freedom off anti-arrhythmic drugs after the PVI was significantly lower in the patients with high-DFs sites overlapping with LVAs than in those without during 11.6±0.8 months of follow-up (35.7% vs. 69.5%, p=0.021). Conclusions High-DF sites overlapping with LVAs detected accurately by the HDG, regardless of whether a minimum to mild extent, might be more selective targets after a PVI in non-paroxysmal AF patients.

Introduction: The impact of catheter ablation for atrial fibrillation (AF) on cardiovascular events and mortality is controversial. We investigated the impact of sinus rhythm maintenance on major adverse cardiac and cerebrovascular events after AF ablation from a Japanese multicenter cohort of AF ablation. Methods and Results: We investigated 2737 consecutive patients (25.6% female, mean age 63.4 ± 10.3 years) who underwent a first catheter ablation for AF from the Atrial Fibrillation registry to Follow the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF Frontier Ablation Registry). The primary endpoint was a composite of stroke, transient ischemic attack, cardiovascular events, and all-cause death. During a mean follow-up of 25.2 months, 2070 (75.6%) patients were free from AF after catheter ablation, and the primary composite endpoint occurred in 122 (4.5%) patients. The AF nonrecurrence group had a significantly lower incidence of the primary endpoint (1.7 per 100 person-years) compared with the AF recurrence group (3.2 per 100 person-years; P = 0.001). The multivariate analysis revealed that freedom from AF (hazard ratio 0.57; 95% confidence interval 0.39–0.83; P = 0.003) was independently associated with the incidence of the composite event.¬¬ Conclusion: In the multicenter cohort of AF ablation, sinus rhythm maintenance after catheter ablation was independently associated with lower rates of major adverse cardiac and cerebrovascular events.