{
  "abstract": "Background: Topological obstacles (TOs), electrically isolated regions such as the mitral annulus and atrial scars, can provide reentry circuits in the left atrium. Their quantity and relationship with low-voltage area (LVA) burden may influence recurrent atrial fibrillation (AF), but this impact remains poorly understood. We aimed to investigate the association between TO count, LVA burden, and post-ablation AF recurrence in patients undergoing de novo AF ablation.\n\nMethods: Patients were categorized by TO counts, identified using pulmonary vein antrum isolation lines and voltage maps. LVA burden (<0.5 mV) was quantified and grouped into quartiles. One-year AF/atrial tachycardia (AT) recurrence was evaluated across groups.\n\nResults: Among 237 patients (mean age 62.4 ± 8.8 years; 27.0% female, paroxysmal AF 42.6%, follow-up 1.0 ± 0. years), the majority had an intermediate TO count (TO = 3, 75.9%). Patients with the lowest TO count (TO = 1, 5.5%) were significantly older, had higher CHA2DS2-VASc scores, worse echocardiographic parameters, and the highest mean LVA burden (36.6% ± 24.8%). AF/AT recurrence occurred in 35.4% of patients. Although recurrence rates were numerically higher in patients with extreme TO counts (TO = 1 or ≥4) and lower in those with intermediate counts (TO = 2 or 3), these differences were not statistically significant (p = 0.433), and the TO group remained non-significantly associated with recurrence after multivariable adjustment for age, AF clinical type, left atrial diameter, left ventricular ejection fraction, CHA2DS2-VASc score, and LVA burden. TO counts differed significantly across LVA burden quartiles (p < 0.001), with the greatest variation observed in the group with the highest LVA burden. Dominant frequency and organization index showed no significant intergroup differences.\n\nConclusion: Patients with extreme TO counts (TO = 1 or ≥4) showed a numerically higher, although not statistically significant, trend toward post-ablation recurrence compared with those with intermediate counts. TO quantity varied significantly with LVA burden, suggesting that atrial substrate heterogeneity may influence AF recurrence patterns.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea",
    "Department of Internal Medicine, Cha University Bundang Medical Center, Seongnam, Republic of Korea",
    "Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea",
    "Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea",
    "Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Republic of Korea",
    "Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "JungMin Choi"
    },
    {
      "affs": [
        0
      ],
      "name": "Young-Hae Go"
    },
    {
      "affs": [
        1
      ],
      "name": "Soonil Kwon"
    },
    {
      "affs": [
        2
      ],
      "name": "Kyung-Yeon Lee"
    },
    {
      "affs": [
        0
      ],
      "name": "Hyo-Jeong Ahn"
    },
    {
      "affs": [
        0,
        3
      ],
      "name": "So-Ryoung Lee"
    },
    {
      "affs": [
        4
      ],
      "name": "Taehun Kim"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Jung Chan Lee"
    },
    {
      "affs": [
        0,
        3
      ],
      "name": "Eue-Keun Choi"
    },
    {
      "affs": [
        0,
        3,
        4
      ],
      "name": "Seil Oh"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8rq2emjnf7q5w.bib",
  "cited_by": 0,
  "doi": "10.3389/fnetp.2026.1945351",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13730920/",
  "id": "8rq2emjnf7q5w",
  "issns": [
    "2674-0109"
  ],
  "landing_url": "https://doi.org/10.3389/fnetp.2026.1945351",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2705|Atrial Fibrillation Management and Outcomes"
    ]
  ],
  "openalex": "W7223132736",
  "pdf_url": "https://www.frontiersin.org/journals/network-physiology/articles/10.3389/fnetp.2026.1945351/pdf",
  "pmcid": "PMC13730920",
  "pmid": "42984502",
  "published": "2026-10-21",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/8rq2emjnf7q5w.ris",
  "sources": [
    {
      "first_seen": "2026-11-07T12:23:53Z",
      "native_id": "PMC13730920",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fnetp.2026.1945351"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Atrial Fibrillation Management and Outcomes",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Impact of low-voltage area burden and topological obstacles on atrial fibrillation recurrence after pulmonary vein antrum isolation",
  "title_text": "Impact of low-voltage area burden and topological obstacles on atrial fibrillation recurrence after pulmonary vein antrum isolation",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T12:21:13Z",
  "url": "https://research.draconitic.com/paper/8rq2emjnf7q5w",
  "venue": "Frontiers in Network Physiology",
  "versions": []
}