Skip to content
DraconiticResearch
Search Sources API
206,690 studies31 sourcesUpdated 27 min ago
Peer-reviewedCC BY 4.0Frontiers in Network Physiology

Impact of low-voltage area burden and topological obstacles on atrial fibrillation recurrence after pulmonary vein antrum isolation

  • JungMin Choi1
  • Young-Hae Go1
  • Soonil Kwon2
  • Kyung-Yeon Lee3
  • Hyo-Jeong Ahn1
  • So-Ryoung Lee1,4
  • Taehun Kim5
  • Jung Chan Lee5,6
  • Eue-Keun Choi1,4
  • Seil Oh1,4,5
6 affiliations
  1. 1Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
  2. 2Department of Internal Medicine, Cha University Bundang Medical Center, Seongnam, Republic of Korea
  3. 3Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
  4. 4Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
  5. 5Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Republic of Korea
  6. 6Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
Read full textPDFDOICite

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.

Methods: 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.

Results: 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.

Conclusion: 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.

Related

  1. Pulmonary Vein Isolation with Different Single-Shot Ablation Devices in Patients with Atrial Fibrillation: A Prospective Observational Single-Center Clinical Evaluation
    Wiktor Czarkowski, Bartłomiej Popielarz, Agata Kukfisz +3
    Medicina (Kaunas, Lithuania)Peer-reviewedCC BYFull textGeneral medicineEurope PMC
  2. Unipolar electrogram-guided vs. ablation index-guided high-power short-duration pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a single-center randomized controlled trial
    Wei-Wei Wang, Si-Qi Li, Hui-Zhong Lin +5
    Quantitative imaging in medicine and surgeryPeer-reviewedCC BY-NC-NDFull textMedical imaging & radiologyEurope PMC
  3. Pulmonary Vein Anatomy, Cooling Kinetics, and Recurrence After Cryoballoon Ablation for Atrial Fibrillation
    Kuo‐Ming Yang, Hsiang‐Chiang Hsiao, Tung‐Chen Yeh +3
    Journal of arrhythmiaPeer-reviewedCC BYFull textCardiovascular medicineEurope PMCPMC
  4. Predictive Value of Left Atrial Strain Combined with Low-Voltage Substrate for Recurrence After Radiofrequency Catheter Ablation in Persistent Atrial Fibrillation
    Diagnostics (Basel, Switzerland)Peer-reviewedCC BYFull textGeneral medicineEurope PMC
  5. The modified APPLE score for predicting atrial fibrillation recurrence in patients with hypertension undergoing radiofrequency ablation
    Luosha Wang, Peng Chang, Xin Ma +4
    Scientific ReportsPeer-reviewedCC BY-NC-ND 4.0Full textCardiovascular medicineCrossref

Cite

BibTeXRIS
BibTeX
@article{choi2026impact,
  title = {{Impact of low-voltage area burden and topological obstacles on atrial fibrillation recurrence after pulmonary vein antrum isolation}},
  author = {JungMin Choi and Young-Hae Go and Soonil Kwon and Kyung-Yeon Lee and Hyo-Jeong Ahn and So-Ryoung Lee and Taehun Kim and Jung Chan Lee and Eue-Keun Choi and Seil Oh},
  journal = {Frontiers in Network Physiology},
  year = {2026},
  month = oct,
  doi = {10.3389/fnetp.2026.1945351},
  url = {https://doi.org/10.3389/fnetp.2026.1945351},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Impact of low-voltage area burden and topological obstacles on atrial fibrillation recurrence after pulmonary vein antrum isolation
AU  - JungMin Choi
AU  - Young-Hae Go
AU  - Soonil Kwon
AU  - Kyung-Yeon Lee
AU  - Hyo-Jeong Ahn
AU  - So-Ryoung Lee
AU  - Taehun Kim
AU  - Jung Chan Lee
AU  - Eue-Keun Choi
AU  - Seil Oh
PY  - 2026
DA  - 2026/10/21
JO  - Frontiers in Network Physiology
DO  - 10.3389/fnetp.2026.1945351
UR  - https://doi.org/10.3389/fnetp.2026.1945351
AB  - 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.  Methods: 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.  Results: 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.  Conclusion: 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.
SN  - 2674-0109
ER  -