{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:57:10Z","timestamp":1790665030585,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,2,16]],"date-time":"2017-02-16T00:00:00Z","timestamp":1487203200000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>This meta\u2010analysis aims to assess the impact of a voltage\u2010guided substrate modification by targeting low\u2010voltage area (LVA) in addition to pulmonary vein isolation (PVI) in patients undergoing catheter ablation for atrial fibrillation (AF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>MEDLINE\/PubMed, Cochrane Library, and references reporting AF ablation and \u201cvoltage* OR substrate* OR fibrosis OR fibrotic area*\u201d were screened and studies included if matching inclusion and exclusion criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six studies were included. Patients enrolled were 885 (517 in the study group and 368 in the control group). Median age was 60 years; 92% had nonparoxysmal AF. At a mean follow\u2010up of 17 months, 70% of patients in the study group vs. 43% in the control group were free from AF\/atrial tachycardia (AT) recurrences (odds ratio [OR]\u00a0= 3.41, 95% confidence interval [CI] 2.22\u20135.24). LVA ablation in addition to PVI was more effective than PVI alone and PVI\u00a0+ conventional wide empirical ablation (70% vs. 43%, OR = 3.41, 95% CI 2.22\u20135.24), without increasing the adverse event rate (2.5% vs. 6%, OR = 0.43, 95% CI 0.15\u20131.26). Compared to PVI + conventional wide empirical ablation, LVA ablation reduced the occurrence of postablation AT (14% vs. 46%, OR = 0.16, 95% CI 0.07\u20130.37), procedure time (176 min vs. 220 min, OR = 0.36, 95% CI 0.24\u20130.56), fluoroscopy time (25 min vs. 31 min, OR = 0.22, 95% CI 0.12\u20130.39), and radiofrequency time (55 min vs. 90 min, OR = 0.49, 95% CI 0.27\u20130.90).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A voltage\u2010guided substrate modification by targeting LVA in addition to PVI is more effective, safer, and holds a lower proarrhythmic potential than conventional ablation approaches. Further randomized studies are necessary to confirm these findings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.13015","type":"journal-article","created":{"date-parts":[[2017,1,5]],"date-time":"2017-01-05T08:52:47Z","timestamp":1483606367000},"page":"199-212","source":"Crossref","is-referenced-by-count":78,"title":["Left Atrial Substrate Modification Targeting Low\u2010Voltage Areas for Catheter Ablation of Atrial Fibrillation: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"40","author":[{"given":"ALESSANDRO","family":"BLANDINO","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine S. 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