# Aanvullende substraatmodificatie bij persisterend AF met low-voltage gebieden

*geplaatst 2025-05-07 · Atriumfibrilleren · 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/euaf095 · https://hartvaat.nl/2025/05/07/aanvullende-substraatmodificatie-bij-persisterend-af-met-low-voltage-gebieden/*

Studie onderzocht welke patiënten met persisterend AF en low-voltage gebieden baat hebben bij aanvullende substraatmodificatie bovenop PVI. Patiënten met uitgebreidere fibrose profiteren het meest.

## English: Persistent atrial fibrillation with left atrial low-voltage area: who benefit from additional modification?

This study investigated which patients with persistent AF and left atrial low-voltage areas benefit from additional substrate modification beyond PVI, identifying subgroups where targeted ablation adds value.

## Abstract (original, from the publication)

AIMS: The presence of low-voltage areas (LVAs) is associated with increased recurrence rate following ablation of persistent atrial fibrillation (PeAF). However, the benefit of additional LVA modification remains controversial. This substudy of the STABLE-SR-II trial aims to explore the factors that influence the benefit of additional LVA ablation for PeAF patients with LVAs. METHODS AND RESULTS: In the STABLE-SR-II trial, PeAF patients with de novo ablation were randomized to receive either circumferential pulmonary vein isolation (CPVI, CPVI-alone group) or CPVI plus LVA ablation (CPVI-plus group). Patients with LVAs were included and analyzed in this substudy. The primary outcome was freedom from atrial arrhythmias 18 months after a single ablation procedure. LVAs were detected in 133 out of 276 PeAF patients (48%). Age and LVA burden were potential factors influencing the relative success of additional LVA ablation compared with CPVI alone in the univariable analysis. In multi-adjusted models, significant benefit from additional LVA ablation was found in patients aged ≥65 years [n = 50, hazard ratio (HR) 0.14, 95% confidence interval (CI) 0.02-0.83] or with LVA burden ≥ 15% (n = 18, HR 0.01, 95% CI: 0-0.44). LVA burden ≥15% was observed in 10 of 50 patients aged ≥65 years (20%) and in 8 of 83 patients aged <65 years (10%). Combined subgroup analysis demonstrated that LVA ablation was particularly beneficial for patients aged ≥65 years, regardless of LVA burden. CONCLUSION: LVA ablation following CPVI may provide additional benefits for older PeAF patients (≥65 years) in the first procedure. CLINICAL TRIAL REGISTRATION: NCT03448562 [CPVI Alone Versus CPVI Plus Electrophysiological Substrate Ablation in the LA During SR for the Treatment of Non-PAF (STABLE-SR_II)].

Auteurs: Hengzhi Zhang, Ning Chen, Qiuheng Bian, Mingchuan Yuan, Gang Yang, Youmei Shen, Hongwu Chen, Weizhu Ju, Mingfang Li, Kai Gu, Nan Wu, Hailei Liu, Minglong Chen

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Bron: 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, https://doi.org/10.1093/europace/euaf095. Bijgewerkt 2026-07-03T18:39:15Z. 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.