Efficacy of left atrial low-voltage area-guided catheter ablation of atrial fibrillation: An updated systematic review and meta-analysis

Aims: This study aimed to evaluate the efficacy of low-voltage area (LVA)-guided substrate modification catheter ablation in patients with atrial fibrillation (AF). Methods: Systematic searches of the PubMed, EMBASE, and Cochrane databases were performed from inception to July 2022 for all available studies. The effect estimates were combined with the Mantel-Haenszel random-effects model. Subgroup analyses, sensitivity analysis, and meta-regression were conducted to explore the sources of statistical heterogeneity. Results: A total of 16 studies involving 1942 subjects (mean age: 61 & PLUSMN; 10 years, 69% male) were identified. All studies included patients with paroxysmal AF, non-paroxysmal AF, or both. At a mean follow-up of 18.9 months, patients who underwent LVA-guided substrate modification ablation had significantly higher freedom from all-atrial tachycardia recurrence than patients who underwent control ablation [67.7% vs. 48.9%, risk ratios (RR) 0.64, 95% confidence interval (CI) 0.55-0.76, P < 0.001], with 36% relative risk and 18.7% absolute risk reductions in all-atrial tachycardia recurrence. Subgroup analysis based on AF types demonstrated that the decreased risk of all-atrial tachycardia recurrence was present predominantly in non-paroxysmal AF compared with paroxysmal AF (RR 0.60, 95% CI 0.52-0.69 vs. RR 0.96, 95% CI 0.81-1.13). Conclusion: Low-voltage area-guided substrate modification ablation combined with PVI appears to have a significant beneficial effect of improving freedom from all-atrial tachycardia recurrence, especially in patients with non-paroxysmal AF.