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Background <p>Catheter ablation (CA) is the principal rhythm-control strategy for atrial fibrillation (AF), yet its long-term success rate remains limited to approximately 60%–80%. Emerging evidence suggests that low-voltage areas (LVAs) in the left atrium (LA) may serve as substrates for AF maintenance. This study investigated whether LVAs in the left anterior atrial wall, caused by mechanical compression from the ascending aorta, could serve as ablation targets to improve procedural success.</p> Methods <p>We retrospectively analyzed six patients with paroxysmal AF who underwent CA at our center. Using the CARTO 3 electroanatomic mapping system combined with intracardiac echocardiography (ICE), three-dimensional reconstructions of the LA and aortic root were generated. LVAs were defined as bipolar voltage amplitude ≤ 0.10 mV. After pulmonary vein isolation (PVI), substrate modification was performed at the anterior LA wall when LVAs were identified. Procedural, mapping, and follow-up data were collected and analyzed.</p> Results <p>All six patients (mean age 61.8 ± 7.1 years; 4 female) presented with paroxysmal AF. LVAs were consistently observed in the left anterior atrial wall at the region of contact with the ascending aorta (width 25.58 ± 10.28&#xa0;mm; length 26.57 ± 8.88&#xa0;mm; LVA percentage 1.78 ± 0.44%). ICE demonstrated anterior wall indentation by the aortic sinus. AF was terminated in all cases during substrate modification of this region, and no recurrence occurred during 12-month follow-up.</p> Conclusion <p>Mechanical compression by the ascending aorta may induce localized LVAs in the anterior LA wall, serving as an arrhythmogenic substrate for AF. Targeted ablation of this LVA region may represent a promising adjunctive strategy to improve CA outcomes, particularly in middle-aged and elderly women with paroxysmal AF.</p> Graphical Abstract <p></p>

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The ablation of the low-voltage area in the left atrial anterior wall caused by mechanical compression from the ascending aorta: a potential strategy for terminating atrial fibrillation

  • 期刊论文

  • 发表日期：

    2026年3月23日

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  • Lu-Yao Mao,
  • Sheng-Wei Li,
  • Ran Yin,
  • Jun-Gang Nie,
  • Qing-Shan Tian,
  • Kun Huang,
  • Xiao-Ping Peng,
  • Zhu-Jian Bing,
  • Ru Ying

摘要

Background

Catheter ablation (CA) is the principal rhythm-control strategy for atrial fibrillation (AF), yet its long-term success rate remains limited to approximately 60%–80%. Emerging evidence suggests that low-voltage areas (LVAs) in the left atrium (LA) may serve as substrates for AF maintenance. This study investigated whether LVAs in the left anterior atrial wall, caused by mechanical compression from the ascending aorta, could serve as ablation targets to improve procedural success.

Methods

We retrospectively analyzed six patients with paroxysmal AF who underwent CA at our center. Using the CARTO 3 electroanatomic mapping system combined with intracardiac echocardiography (ICE), three-dimensional reconstructions of the LA and aortic root were generated. LVAs were defined as bipolar voltage amplitude ≤ 0.10 mV. After pulmonary vein isolation (PVI), substrate modification was performed at the anterior LA wall when LVAs were identified. Procedural, mapping, and follow-up data were collected and analyzed.

Results

All six patients (mean age 61.8 ± 7.1 years; 4 female) presented with paroxysmal AF. LVAs were consistently observed in the left anterior atrial wall at the region of contact with the ascending aorta (width 25.58 ± 10.28 mm; length 26.57 ± 8.88 mm; LVA percentage 1.78 ± 0.44%). ICE demonstrated anterior wall indentation by the aortic sinus. AF was terminated in all cases during substrate modification of this region, and no recurrence occurred during 12-month follow-up.

Conclusion

Mechanical compression by the ascending aorta may induce localized LVAs in the anterior LA wall, serving as an arrhythmogenic substrate for AF. Targeted ablation of this LVA region may represent a promising adjunctive strategy to improve CA outcomes, particularly in middle-aged and elderly women with paroxysmal AF.

Graphical Abstract