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\begin{document}

\title{Acute and long-term outcomes of pulmonary vein isolation and ablation of
low-voltage areas for non-paroxysmal atrial fibrillation}



\author[1]{Wenchao Huang}%
\author[1]{Yan Luo}%
\author[1]{Guoshu Yang}%
\author[1]{duan luo}%
\author[1]{Shiqiang Xiong}%
\author[1]{Yu Long}%
\author[1]{Hanxiong Liu}%
\affil[1]{Chengdu Third People's Hospital}%


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  \date{May 25, 2024}


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\begin{abstract}
\textbf{Introduction:} Pulmonary vein isolation is not sufficient for
the treatment of non-paroxysmal atrial fibrillation (AF). We aimed to
clarify the effects of pulmonary vein isolation and left atrial
low-voltage area ablation on acute termination of AF and freedom from
AF. \textbf{Methods:} Ninety-five patients with non-paroxysmal AF were
prospectively divided into left atrial substrates modification-first
(LASM-first, n=47) and pulmonary vein isolation-first (PVI-first, n=48)
groups. All patients underwent ablation during AF with acute AF
termination as the procedural endpoint. In the former, LASM was
performed, and PVI was performed only if AF termination was
unsuccessful. In the latter, PVI was performed to observe whether AF was
terminated, and if not, LASM was performed. In non-terminating AF,
electrical cardioversion was performed. The patients were followed up 3,
6, and 12 months after ablation. \textbf{Results:} More patients reached
the procedural endpoint with LASM alone than with PVI alone (45\% vs.
15\%; P \textless{} 0.01). Of the 95 patients, acute termination of AF
occurred in 67 patients (70.5%) after PVI combined with LASM. At a
median follow-up of 15 months, 69 of 95 patients (72.6%) achieved
freedom from AF. More patients with AF termination with LASM alone
achieved freedom from AF when compared to those who had undergone PVI
alone (86\% vs. 43\%; P=0.04). \textbf{Conclusions:} LASM terminated
non-paroxysmal AF in nearly half of the cases, with a better rate of
freedom from AF when compared to cases without AF termination. However,
for PVI, AF termination did not lead to better AF freedom rate.%
\end{abstract}%



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