{"id":"fd31d4de9d83","type":"article","url":"https://hartvaat.nl/2018/11/01/individueel-aangepaste-versus-gestandaardiseerde-substraatmodificatie-bij-rf-abl/","title":"Individueel aangepaste versus gestandaardiseerde substraatmodificatie bij RF-ablatie voor AF","title_en":"Individually tailored vs. standardized substrate modification during radiofrequency catheter ablation for atrial fibrillation: a randomized study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"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","doi":"10.1093/europace/eux310","source_url":"https://doi.org/10.1093/europace/eux310","authors":["Simon Kircher","Arash Arya","David Altmann","Sascha Rolf","Andreas Bollmann","Philipp Sommer","Nikolaos Dagres","Sergio Richter","Ole-A Breithardt","Borislav Dinov","Daniela Husser","Charlotte Eitel","Thomas Gaspar","Christopher Piorkowski","Gerhard Hindricks"],"significance":5,"published":"2018-11-01","source_date":"2018-11-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial compared individually tailored (voltage-guided) with standardized substrate modification during AF radiofrequency ablation, testing whether personalized ablation targets improve rhythm outcomes.","created":"2026-07-03T10:27:35Z","updated":"2026-07-03T13:26:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die geïndividualiseerde versus gestandaardiseerde substraatmodificatie vergeleek bij radiofrequentieablatie voor AF.","abstract_original":"AIMS: This randomized single-centre study sought to compare the efficacy and safety of pulmonary vein isolation (PVI) plus voltage-guided ablation vs. PVI with or without linear ablation depending on the type of atrial fibrillation (AF). METHODS AND RESULTS: Overall, 124 ablation-naive patients with paroxysmal or persistent AF were randomized to PVI with (persistent AF) or without (paroxysmal AF) additional linear ablation (control group) vs. PVI plus ablation of low-voltage areas (LVAs) irrespective of AF type. Bipolar voltage mapping was performed during stable sinus rhythm. An LVA consisted of  ≥ 3 adjacent mapping points that each had a peak-to-peak amplitude ≤0.5 mV. After a mean follow-up of 12 ± 3 months, significantly more patients in the LVA ablation group were free from atrial arrhythmia recurrence >30 s off antiarrhythmic drugs (AADs) after a single procedure (primary endpoint) compared with control group patients [40/59 (68%) vs. 25/59 (42%), log-rank P = 0.003]. Arrhythmia-free survival on or off AADs was found in 33/59 control group patients (56%) and in 41/59 LVA ablation group patients (70%) (adjusted log-rank P = 0.10). During the 7 day Holter monitoring period at 12 months, significantly more patients in the LVA ablation group were free from arrhythmia recurrence on or off AADs [45/50 (90%) vs. 33/46 (72%), P = 0.04]. No between-group differences were observed regarding procedure duration, fluoroscopy time, and major complications. CONCLUSION: In this single-centre study, individually tailored substrate modification guided by voltage mapping was associated with a significantly higher arrhythmia-free survival rate compared with a conventional approach applying linear ablation according to AF type."}