{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T09:20:48Z","timestamp":1791537648157,"version":"4.3.4"},"reference-count":21,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Arrhythmia"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Left atrial low\u2010voltage areas (LVAs) represent an arrhythmogenic substrate in atrial fibrillation (AF). LVA\u2010targeted ablation is increasingly used as an adjunct to pulmonary vein isolation (PVI), yet outcomes vary across randomized trials, potentially due to differences in ablation strategy. We performed a meta\u2010analysis to evaluate the effectiveness of LVA\u2010targeted ablation added to PVI and to assess whether treatment effects differ between LVA isolation and LVA homogenization strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA, we systematically searched PubMed and CENTRAL for randomized controlled trials (RCTs). Eligible studies enrolled patients with any AF type undergoing voltage mapping and compared PVI plus LVA\u2010targeted ablation (PVI\u2009+\u2009LVA) with PVI alone. The primary outcome was AF\/atrial tachyarrhythmia recurrence during follow\u2010up, as defined in each trial. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random\u2010effects model. Subgroup analyses were performed according to the predominant LVA strategy (isolation vs. homogenization).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Six RCTs involving 1565 patients (PVI\u2009+\u2009LVA,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009780; PVI alone,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009785) were included. Overall, PVI\u2009+\u2009LVA reduced recurrence compared with PVI alone (OR 0.72; 95% CI 0.54\u20130.96). In strategy\u2010specific analyses, LVA isolation was associated with a significant reduction in recurrence (OR 0.57; 95% CI 0.38\u20130.87), whereas LVA homogenization showed a smaller and non\u2010significant effect (OR 0.85; 95% CI 0.59\u20131.24). Between\u2010strategy heterogeneity was substantial (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200990.4%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In RCTs of AF ablation, adding LVA\u2010targeted ablation to PVI reduced arrhythmia recurrence. The treatment effect appeared more pronounced with LVA isolation than with homogenization; however, these strategy\u2010specific findings should be considered exploratory and require confirmation in future randomized studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/joa3.70430","type":"journal-article","created":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T21:47:48Z","timestamp":1785102468000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Strategy\u2010Specific Effects of Low\u2010Voltage Area\u2013Targeted Ablation Added to Pulmonary Vein Isolation: A Meta\u2010Analysis of Randomized Controlled Trials"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2590-6696","authenticated-orcid":false,"given":"Akihiro","family":"Sunaga","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine The University of Osaka Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine The University of Osaka Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisaku","family":"Nakatani","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine The University of Osaka Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuki","family":"Okada","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine The University of Osaka Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirota","family":"Kida","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine The University of Osaka Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Matsuoka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine The University of Osaka Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideaki","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine The University of Osaka Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuhisa","family":"Kitamura","sequence":"additional","affiliation":[{"name":"Department of Social and Environmental Medicine The University of Osaka Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaharu","family":"Masuda","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Kansai Rosai Hospital  Amagasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7564-2978","authenticated-orcid":false,"given":"Yohei","family":"Sotomi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine The University of Osaka Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Sakata","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine The University of Osaka Graduate School of Medicine  Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,26]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2017.05.012"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001193"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa612"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1408288"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1148\/ryct.220061"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13321"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.113.001251"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2023.1749"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/EVIDoa2200141"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2025.05.064"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-21-0476"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-025-03674-y"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2022.03.012"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euac089"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.16290"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.16723"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1113\/JP270617"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jccase.2023.05.009"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.88.3.915"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.113.000264"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.07.043"}],"container-title":["Journal 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