{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:42:23Z","timestamp":1789731743161,"version":"4.0.1"},"reference-count":68,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>In the left atrium (LA), low-voltage areas (LVAs) detected at electroanatomic mapping in patients with atrial fibrillation (AF) are considered expression of atrial cardiomyopathy (AtCM). This meta-analysis aims at assessing the prevalence and predictors of LVAs in a larger AF population undergoing catheter ablation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Studies comparing patients undergoing LA ablation with vs. those without LVAs were included. Meta-analyses were conducted to estimate the prevalence and odds ratios (ORs) for LVAs. Twenty-two studies with 5278 patients were included. Low-voltage areas were present both in paroxysmal (28%) and non-paroxysmal (41%) patients. The strongest predictors of LVA presence were: age &amp;gt; 65 years (OR 3.41), CHA2DS2-VASc score (OR 3.29), non-paroxysmal AF (OR 3.19), NT-proBNP &amp;gt; 365\u2005pg\/mL (OR 2.47), female sex (OR 2.40), E\/e\u2032 ratio (OR 2.31), eGFR &amp;lt; 60\u2005mL\/min\/m2 (OR 2.28), and LA volume indexed &amp;gt; 34\u2005mL\/m2 (OR 1.98). Comorbidities were also predictors but with lower ORs. In subgroup analysis, female sex (OR 3.90) was a predictor only in non-paroxysmal, while LA diameter (OR 2.51) and body mass index (BMI; OR 1.85) positively correlated only in paroxysmal AF. Meta-regression analysis showed that non-paroxysmal AF and age were independently and significantly associated with a greater reduction in BMI in patients with compared to those without LVAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Low-voltage areas can be present in both paroxysmal and non-paroxysmal AF, and can be predicted by multiple clinical, echocardiographic, and biomarker variables. The impact of female sex, LA diameter, and BMI on LVA presence varies according to the type of AF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euaf206","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T11:24:41Z","timestamp":1756725881000},"source":"Crossref","is-referenced-by-count":6,"title":["Prevalence and multiple predictors of left atrial low voltage in paroxysmal and non-paroxysmal atrial fibrillation patients undergoing ablation: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6126-5448","authenticated-orcid":false,"given":"Carlo-Agostino","family":"Oliva","sequence":"first","affiliation":[{"name":"Unit\u00e0 Operativa di Cardiologia, Ospedale di Circolo, ASST Settelaghi, Viale Borri 57 , Varese 21100 ,","place":["Italy"]},{"name":"School of Cardiology, University of Brescia \u00a0 Brescia 25121 ,","place":["Italy"]},{"name":"Unit\u00e0 Operativa di Cardiologia, Ospedale San Pellegrino , Castiglione delle Stiviere, Mantua 46043 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4848-523X","authenticated-orcid":false,"given":"Matteo","family":"Morello","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa di Cardiologia, Ospedale di Circolo, ASST Settelaghi, Viale Borri 57 , Varese 21100 ,","place":["Italy"]},{"name":"Department of Molecular and Translational Medicine, University of Brescia \u00a0 Brescia 25121 ,","place":["Italy"]},{"name":"Robert M. Berne Cardiovascular Research Center, University of Virginia , Charlottesville, VA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3397-0535","authenticated-orcid":false,"given":"Jordana","family":"Kron","sequence":"additional","affiliation":[{"name":"Pauley Heart Center, Virginia Commonwealth University , Richmond, VA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8527-569X","authenticated-orcid":false,"given":"Kenneth A","family":"Ellenbogen","sequence":"additional","affiliation":[{"name":"Pauley Heart Center, Virginia Commonwealth University , Richmond, VA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0141-0127","authenticated-orcid":false,"given":"Michele","family":"Golino","sequence":"additional","affiliation":[{"name":"Robert M. Berne Cardiovascular Research Center, University of Virginia , Charlottesville, VA ,","place":["USA"]},{"name":"Pauley Heart Center, Virginia Commonwealth University , Richmond, VA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3278-1721","authenticated-orcid":false,"given":"Roberto","family":"De Ponti","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa di Cardiologia, Ospedale di Circolo, ASST Settelaghi, Viale Borri 57 , Varese 21100 ,","place":["Italy"]},{"name":"Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9 , Varese 21100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"key":"2025092305313093200_euaf206-B1","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.hrthm.2023.11.032","article-title":"Atrial fibrillation begets atrial fibrillation: the role of electroanatomic remodeling","volume":"21","author":"Allessie","year":"2024","journal-title":"Heart Rhythm"},{"key":"2025092305313093200_euaf206-B2","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.jacc.2007.09.064","article-title":"Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation","volume":"51","author":"Burstein","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"2025092305313093200_euaf206-B3","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1093\/europace\/euw161","article-title":"EHRA\/HRS\/APHRS\/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication","volume":"18","author":"Goette","year":"2016","journal-title":"Europace"},{"key":"2025092305313093200_euaf206-B4","doi-asserted-by":"crossref","first-page":"1758","DOI":"10.1161\/CIRCULATIONAHA.108.811877","article-title":"Detection and quantification of left atrial structural remodeling with delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation","volume":"119","author":"Oakes","year":"2009","journal-title":"Circulation"},{"key":"2025092305313093200_euaf206-B5","doi-asserted-by":"crossref","first-page":"e024521","DOI":"10.1161\/JAHA.121.024521","article-title":"Atrial structural remodeling in patients with atrial fibrillation is a diffuse fibrotic process: evidence from high-density voltage mapping and atrial biopsy","volume":"11","author":"Yamaguchi","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"2025092305313093200_euaf206-B6","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euae204","article-title":"Atrial cardiomyopathy revisited-evolution of a concept: a clinical consensus statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS)","volume":"26","author":"Goette","year":"2024","journal-title":"Europace"},{"key":"2025092305313093200_euaf206-B7","doi-asserted-by":"crossref","first-page":"3339","DOI":"10.1093\/eurheartj\/ehad396","article-title":"Histological validation of atrial structural remodelling in patients with atrial fibrillation","volume":"44","author":"Takahashi","year":"2023","journal-title":"Eur Heart J"},{"key":"2025092305313093200_euaf206-B8","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euae043","article-title":"2024 European Heart Rhythm Association\/Heart Rhythm Society\/Asia Pacific Heart Rhythm Society\/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation","volume":"26","author":"Tzeis","year":"2024","journal-title":"Europace"},{"key":"2025092305313093200_euaf206-B9","first-page":"525","article-title":"Atrial fibrillation risk scores to evaluate left atrial substrate based on voltage analysis in long-standing persistent type of arrhythmia","volume":"79","author":"Kiedrowicz","year":"2021","journal-title":"Kardiol Pol"},{"key":"2025092305313093200_euaf206-B10","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2025092305313093200_euaf206-B11","doi-asserted-by":"crossref","first-page":"n160","DOI":"10.1136\/bmj.n160","article-title":"PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2025092305313093200_euaf206-B12","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","article-title":"Meta-analysis of observational studies in epidemiology: a proposal for reporting. 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