{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T22:27:12Z","timestamp":1791239232047,"version":"4.1.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Electrical remodeling precedes structural remodeling. In adjunctive left atrial (LA) low-voltage area (LVA) ablation to pulmonary vein isolation of atrial fibrillation (AF), LA areas without LVA have not been targeted for ablation. We studied the effect of adjunctive LA posterior wall isolation (PWI) on persistent AF without LA-LVA according to electrophysiological testing (EP test).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We examined consecutive patients with persistent AF with (n=33) and without (n=111) LA-LVA. Patients without LA-LVA were randomly assigned to EP test\u2013guided (n=57) and control (n=54) groups. In the EP test\u2013guided group, an adjunctive PWI was performed in those with positive results (PWI subgroup; n=24), but not in those with negative results (n=33). The criteria for positive EP tests were an effective refractory period \u2264180 ms, effective refractory period&gt;20 ms shorter than the other sites, and\/or induction of AF\/atrial tachycardia (AT) during measurements. LVA ablation was performed in the patients with LA-LVA.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              During the follow-up period (62\u00b133 weeks), the EP test\u2013guided group had significantly lower recurrence rates (19%,11\/57 versus 41%, 22\/54,\n              <jats:italic>P<\/jats:italic>\n              =0.012) and higher Kaplan-Meier AF\/AT\u2013free survival curve rates than the control group (\n              <jats:italic>P<\/jats:italic>\n              =0.01). No significant differences in the recurrence and AF\/AT\u2013free survival curve rates between the PWI (positive EP test) and non-PWI (negative EP test) subgroups were observed. Therefore, PWI for positive EP tests reduced the AF\/AT recurrence in the EP test\u2013guided group. A stepwise Cox proportional hazard analyses identified EP test\u2013guided ablation as a factor reducing the recurrence rate. The recurrence rates in the LA-LVA ablation group and EP test\u2013guided group were similar.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>This pilot study proposed that an EP test\u2013guided adjunctive PWI of persistent AF without LA-LVA potentially reduced AF\/AT recurrences. The results suggest that there is an AF substrate in the LA with altered electrophysiological function even when there is no LA-LVA.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphic Abstract:<\/jats:title>\n            <jats:p>\n              A\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"graphic abstract\">graphic abstract<\/jats:ext-link>\n              is available for this article.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.119.008191","type":"journal-article","created":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T02:27:40Z","timestamp":1594693660000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Efficacy of an Adjunctive Electrophysiological Test\u2013Guided Left Atrial Posterior Wall Isolation in Persistent Atrial Fibrillation Without a Left Atrial Low-Voltage Area"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7758-154X","authenticated-orcid":true,"given":"Hirosuke","family":"Yamaji","sequence":"first","affiliation":[{"name":"Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Japan (H.Y., S. Higashiya, T.M., K.H., H.K., M.M., S. Kamikawa, S. Kusachi)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunichi","family":"Higashiya","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Japan (H.Y., S. Higashiya, T.M., K.H., H.K., M.M., S. Kamikawa, S. Kusachi)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Murakami","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Japan (H.Y., S. Higashiya, T.M., K.H., H.K., M.M., S. Kamikawa, S. Kusachi)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuyoshi","family":"Hina","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Japan (H.Y., S. Higashiya, T.M., K.H., H.K., M.M., S. Kamikawa, S. Kusachi)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9590-2311","authenticated-orcid":true,"given":"Hiroshi","family":"Kawamura","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Japan (H.Y., S. Higashiya, T.M., K.H., H.K., M.M., S. Kamikawa, S. Kusachi)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaaki","family":"Murakami","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Japan (H.Y., S. Higashiya, T.M., K.H., H.K., M.M., S. Kamikawa, S. Kusachi)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeshi","family":"Kamikawa","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Japan (H.Y., S. Higashiya, T.M., K.H., H.K., M.M., S. Kamikawa, S. Kusachi)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Hirohata","sequence":"additional","affiliation":[{"name":"Department of Medical Technology, Okayama University Graduate School of Health Sciences, Japan (S. Hirohata, S. Kusachi)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shozo","family":"Kusachi","sequence":"additional","affiliation":[{"name":"Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Japan (H.Y., S. Higashiya, T.M., K.H., H.K., M.M., S. Kamikawa, S. Kusachi)."},{"name":"Department of Medical Technology, Okayama University Graduate School of Health Sciences, Japan (S. Hirohata, S. 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