{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:02:52Z","timestamp":1789707772330,"version":"4.0.1"},"reference-count":20,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"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":["Pacing Clinical Electrophis"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Atrial fibrillation (AF) frequently coexists with heart failure with preserved ejection fraction (HFpEF), and low\u2010voltage zones (LVZs) in the atria represent atrial remodeling. However, the impact of HFpEF on the extent and distribution of LVZs and ablation outcomes remains unknown.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To characterize LVZs in patients with HFpEF undergoing AF ablation and evaluate their association with arrhythmia recurrence.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A total of 128 consecutive patients (66\u00b112 years) who underwent AF ablation for the first time were retrospectively analyzed. HFpEF was defined as a left ventricular ejection fraction >50% with a history of heart failure treatment or an HFA\u2010PEFF score \u22655. Meanwhile, LVZs were defined as bipolar voltage <0.5\u00a0mV and quantified across five left atrial regions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Forty\u2010seven patients (36.7%) were diagnosed with HFpEF. LVZs were significantly more extensive in the overall left atrium in the HFpEF group (16.3\u00b113.5\u00a0vs. 8.2\u00b17.6 cm\n 2<\/jats:sup>\n ,\n p<\/jats:italic>\n < 0.001), with the greatest difference being observed in the anterior wall (5.6\u00b15.4\u00a0vs. 2.3\u00b12.8 cm\n 2<\/jats:sup>\n ,\n p<\/jats:italic>\n < 0.001). During 9\u00b14 months, arrhythmia recurrence rates did not differ significantly between HFpEF and non\u2010HFpEF groups (12.8%\u00a0vs. 13.6%,\n p<\/jats:italic>\n = 0.310). Posterior wall isolation was more frequently performed in the HFpEF group (27.6%\u00a0vs. 4.9%,\n p<\/jats:italic>\n < 0.001). In multivariable analysis, HFpEF, age, and persistent AF were independent determinants of LVZ extent.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n AF patients with HFpEF exhibit more extensive LVZs, indicating advanced atrial remodeling. Despite differences in atrial substrate and ablation strategy, arrhythmia recurrence rates were comparable between patients with and without HFpEF.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/pace.70415","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:03:58Z","timestamp":1789704238000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Characteristics of Low\u2010Voltage Zones in Patients With Heart Failure With Preserved Ejection Fraction"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0020-8543","authenticated-orcid":false,"given":"Shuntaro","family":"Tamura","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Gunma University Graduate School of Medicine Maebashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5427-5048","authenticated-orcid":false,"given":"Yosuke","family":"Nakatani","sequence":"additional","affiliation":[{"name":"Division of Non\u2010pharmacological Management of Cardiac Arrhythmias Gunma University Graduate School of Medicine Maebashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Soga","sequence":"additional","affiliation":[{"name":"ME Supply Center Gunma University Hospital Maebashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryutaro","family":"Iwai","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Gunma University Graduate School of Medicine Maebashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Gunma University Graduate School of Medicine Maebashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Sano","sequence":"additional","affiliation":[{"name":"ME Supply Center Gunma University Hospital Maebashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9635-2769","authenticated-orcid":false,"given":"Tadashi","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Gunma University Graduate School of Medicine Maebashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9611-2303","authenticated-orcid":false,"given":"Yoshiaki","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Gunma University Graduate School of Medicine Maebashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4348-0123","authenticated-orcid":false,"given":"Hideki","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Gunma University Graduate School of Medicine Maebashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"4277","DOI":"10.1093\/eurheartj\/ehy626","article-title":"Prognostic Implications of Atrial Fibrillation in Heart Failure With Reduced, Mid\u2010Range, and Preserved Ejection Fraction: A Report From 14 964 Patients in the European Society of Cardiology Heart Failure Long\u2010Term Registry","volume":"39","author":"Zafrir B.","year":"2018","journal-title":"European Heart Journal"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1161\/CIRCULATIONAHA.113.001475","article-title":"Temporal Relationship and Prognostic Significance of Atrial Fibrillation in Heart Failure Patients With Preserved Ejection Fraction: A Community\u2010Based Study","volume":"128","author":"Zakeri R.","year":"2013","journal-title":"Circulation"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1016\/j.cardfail.2009.06.440","article-title":"Increased Atrial Contribution to Left Ventricular Filling Compensates for Impaired Early Filling during Exercise in Heart Failure with Preserved Ejection Fraction","volume":"15","author":"Phan T. T.","year":"2009","journal-title":"J Card Fail"},{"key":"e_1_2_8_5_1","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.121.024521","article-title":"Atrial Structural Remodeling in Patients With Atrial Fibrillation is a Diffuse Fibrotic Process: Evidence from High\u2010Density Voltage Mapping and Atrial Biopsy","volume":"11","author":"Yamaguchi T.","year":"2022","journal-title":"Journal of the American Heart Association"},{"key":"e_1_2_8_6_1","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ijcard.2017.12.089","article-title":"Left Atrial Low\u2010Voltage Areas Predict Atrial Fibrillation Recurrence after Catheter Ablation in Patients with Paroxysmal Atrial Fibrillation","volume":"257","author":"Masuda M.","year":"2018","journal-title":"International Journal of Cardiology"},{"key":"e_1_2_8_7_1","doi-asserted-by":"crossref","first-page":"3297","DOI":"10.1093\/eurheartj\/ehz641","article-title":"How to Diagnose Heart Failure with Preserved Ejection Fraction: The HFA\u2010PEFF Diagnostic Algorithm: A Consensus Recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)","volume":"40","author":"Pieske B.","year":"2019","journal-title":"European Heart Journal"},{"key":"e_1_2_8_8_1","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.hrthm.2006.10.017","article-title":"Regional Left Atrial Voltage in Patients With Atrial Fibrillation","volume":"4","author":"Marcus G. 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