{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T17:06:45Z","timestamp":1773335205545,"version":"3.50.1"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Delayed catheter ablation (CA) has been associated with higher rates of atrial fibrillation (AF) recurrence. Low-voltage zones (LVZs) are established predictors of AF recurrence after CA. Data on LVZ assessment in relation to diagnosis-to-ablation time (DAT) remain limited. This study aimed to evaluate the extent of left atrial (LA) LVZs, bipolar voltage, and the outcomes of voltage-guided CA in patients with persistent AF, classified according to DAT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We consecutively enrolled 350 patients with persistent AF undergoing their first voltage-guided CA. Patients were classified according to DAT into two groups: DAT \u22641 year (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009131) and &amp;gt;1 year (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009219). LA voltage mapping was performed during sinus rhythm. LVZs were defined as regions with a bipolar voltage &amp;lt;0.5\u2005mV.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with DAT &amp;gt;1 year exhibited lower LA bipolar voltage (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.01) and larger LA and indexed LA volumes (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.01). LVZs were more frequent in this group (43% vs. 28%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01), particularly moderate LVZs (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). Recurrence of atrial tachyarrhythmias (ATs) after a single procedure occurred more often in patients with DAT &amp;gt;1 year (log-rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05). Multivariable analysis revealed that female sex (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), indexed LA volume \u226548\u2005mL\/m\n                      <jats:sup>2<\/jats:sup>\n                      (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008), age \u226560 years (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05), and P-wave duration \u2265150\u2005ms (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) were independently associated with the presence of LVZs. A history of paroxysmal AF was associated with a lower likelihood of LVZs, whereas DAT was not an independent predictor.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with persistent AF and a longer DAT displayed more extensive LA substrate remodeling. Despite a tailored ablation targeting LVZs, a longer DAT was associated with a higher rate of AT recurrence. Early ablation within the first year after AF diagnosis could optimize AF CA outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1751432","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T05:29:10Z","timestamp":1773293350000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of diagnosis-to-ablation time on left atrial remodeling and voltage-guided ablation outcome in persistent atrial fibrillation patients"],"prefix":"10.3389","volume":"13","author":[{"given":"Halim","family":"Marzak","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Nouvel H\u00f4pital Civil, Strasbourg University Hospital","place":["Strasbourg, France"]},{"name":"UR 3074 Translational CardioVascular Medicine, CRBS, University of Strasbourg","place":["Strasbourg, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fran\u00e7ois","family":"Severac","sequence":"additional","affiliation":[{"name":"Public Health Service, Groupe M\u00e9thodes en Recherche Clinique (GMRC), Strasbourg University Hospital","place":["Strasbourg, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cl\u00e9ment","family":"Baldacini","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Nouvel H\u00f4pital Civil, Strasbourg University Hospital","place":["Strasbourg, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Fitouchi","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Nouvel H\u00f4pital Civil, Strasbourg University Hospital","place":["Strasbourg, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loic","family":"Faucher","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Nouvel H\u00f4pital Civil, Strasbourg University Hospital","place":["Strasbourg, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julien","family":"Jacques","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Nouvel H\u00f4pital Civil, Strasbourg University Hospital","place":["Strasbourg, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Cardi","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Nouvel H\u00f4pital Civil, Strasbourg University Hospital","place":["Strasbourg, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamad","family":"Kanso","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Nouvel H\u00f4pital Civil, Strasbourg University Hospital","place":["Strasbourg, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre","family":"Schatz","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Nouvel H\u00f4pital Civil, Strasbourg University Hospital","place":["Strasbourg, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Ohlmann","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Nouvel H\u00f4pital Civil, Strasbourg University Hospital","place":["Strasbourg, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivier","family":"Morel","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Nouvel H\u00f4pital Civil, Strasbourg University Hospital","place":["Strasbourg, France"]},{"name":"UR 3074 Translational CardioVascular Medicine, CRBS, University of Strasbourg","place":["Strasbourg, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurence","family":"Jesel","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Nouvel H\u00f4pital Civil, Strasbourg University Hospital","place":["Strasbourg, France"]},{"name":"UR 3074 Translational CardioVascular Medicine, CRBS, University of Strasbourg","place":["Strasbourg, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1161\/01.CIR.98.10.946","article-title":"Impact of atrial fibrillation on the risk of death: the Framingham Heart Study","volume":"98","author":"Benjamin","year":"1998","journal-title":"Circulation"},{"key":"B2","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1212\/WNL.28.10.973","article-title":"Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham 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