{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T09:20:51Z","timestamp":1791537651103,"version":"4.3.4"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>In the randomized controlled SUPPRESS-AF trial (Efficacy and Safety of Left Atrial Low-voltage Area Guided Ablation for Recurrence Prevention Compared to Pulmonary Vein Isolation Alone in Patients with Persistent Atrial Fibrillation), the efficacy of low-voltage-area (LVA) ablation was highly dependent on the degree of atrial remodeling, while the efficacy was not statistically significant in total patients. This subanalysis of the SUPPRESS-AF trial aimed to compare the efficacy of LVA ablation in patient groups classified by left atrial diameter (LAD), which is a commonly used atrial remodeling index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>The SUPPRESS-AF trial included patients with persistent AF and left atrial LVAs, and compared rhythm outcomes between patients randomized to undergo pulmonary vein isolation (PVI) followed by left atrial LVA ablation group (n=170) or PVI-alone group (n=172). In this post hoc subanalysis, patients in each of the 2 randomly allocated groups were further divided into 2 groups using a median LAD of 44 mm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Atrial fibrillation or atrial tachycardia recurrence\u2013free rates did not differ between patients with LAD&gt;44 mm and \u226444 mm (60.1% versus 53.7%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.261). Among patients with a LAD&gt;44 mm, the LVA ablation group demonstrated a higher atrial fibrillation or atrial tachycardia-recurrence\u2013free rate than the PVI-alone group (62.5% versus 43.4%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.016). In contrast, no difference in atrial fibrillation or atrial tachycardia recurrence\u2013free rate was found between the 2 groups of patients with a LAD\u226444 mm (60.8% versus 59.6%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.986).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>The efficacy of LVA ablation in addition to PVI for the treatment of persistent AF was more pronounced in patients with a large left atrium.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.umin.ac.jp\/ctr\">https:\/\/www.umin.ac.jp\/ctr<\/jats:ext-link>\n                      ; Unique identifier: UMIN000035940.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circep.125.014210","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T09:02:26Z","timestamp":1758877346000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Efficacy of Low-Voltage-Area Ablation Is Enhanced in Patients With Advanced Left Atrial Enlargement: A Subanalysis of the SUPPRESS-AF Trial"],"prefix":"10.1161","volume":"18","clinical-trial-number":[{"clinical-trial-number":"umin000035940","registry":"10.18810\/umin-japan"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5566-466X","authenticated-orcid":true,"given":"Masaharu","family":"Masuda","sequence":"first","affiliation":[{"name":"Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan (M.M., Y.M., H.U., H.O., S.K., M. 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