{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T03:26:43Z","timestamp":1791516403746,"version":"4.3.4"},"reference-count":41,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,4,10]],"date-time":"2022-04-10T00:00:00Z","timestamp":1649548800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The posterior wall (PW) has been proposed as a standard target for ablation beyond pulmonary vein antral isolation\u00a0(PVI) in patients with persistent atrial fibrillation\u00a0(AF). However, studies have shown inconsistent outcomes with the addition of PW ablation. The presence or absence of low voltage on the PW may explain these inconsistencies. We evaluated whether PW ablation based on the presence or absence of low voltage improves long\u2010term arrhythmia\u2010free outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed 5\u2010year follow\u2010up in 152 consecutive patients who received either standard ablation (SA) with PVI alone or PVI\u2009+\u2009PW ablation (PWA) based on physician discretion (<jats:italic>n<\/jats:italic>\u2009=\u200977) or voltage\u2010guided ablation (VGA) with PVI and addition of PWA only if low voltage was present on the PW (<jats:italic>n<\/jats:italic>\u2009=\u200975).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The two groups were well matched for baseline characteristics. At 5\u2010year follow\u2010up, 64% of patients receiving VGA were atrial tachyarrhythmia\u00a0(AT)\/AF free compared to 34% receiving SA (HR 0.358 <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.005). PWA had similar AF recurrence in SA and VGA groups (0.30 vs. 0.27 <jats:italic>p<\/jats:italic>\u2009=\u2009.96) but higher AT recurrence when comparing SA and VGA groups (0.39 vs. 0.15 <jats:italic>p<\/jats:italic>\u2009=\u2009.03). In multivariate analysis, both VGA and PWA predicted AF arrhythmia\u2010free survival (HR 0.33, <jats:italic>p<\/jats:italic>\u2009=\u2009.001 and HR 0.20, <jats:italic>p<\/jats:italic>\u2009=\u2009.008, respectively). For AT, VGA predicted arrhythmia\u2010free survival (HR 0.22, <jats:italic>p<\/jats:italic>\u2009=\u2009.028), while PWA predicted AT recurrence (HR 4.704, <jats:italic>p<\/jats:italic>\u2009=\u2009.0219).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>VGA of the posterior wall ablation beyond PVI in persistent AF significantly improves long\u2010term arrhythmia\u2010free survival when compared with non\u2010voltage\u2010guided ablation. PW ablation without voltage\u2010guidance reduced AF recurrence but at the cost of a higher incidence of AT.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15464","type":"journal-article","created":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T05:12:48Z","timestamp":1648185168000},"page":"2475-2484","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Low voltage\u2010guided ablation of posterior wall improves 5\u2010year arrhythmia\u2010free survival in persistent atrial fibrillation"],"prefix":"10.1111","volume":"33","author":[{"given":"Michael J.","family":"Cutler","sequence":"first","affiliation":[{"name":"Intermountain Medical Center Heart Institute, Intermountain Medical Center  Murray Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasongchai","family":"Sattayaprasert","sequence":"additional","affiliation":[{"name":"Deaconess Hospital  Evansville Indiana 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