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Background  This study aimed to evaluate the atrial substrate in the left atrium ( LA ) by low‐voltage areas ( LVA s) and high‐dominant frequencies ( DF s) after circumferential pulmonary vein isolation ( PVI ) in nonparoxysmal atrial fibrillation ( AF ).    Methods  In 70 patients with nonparoxysmal  AF  patients (41 persistent  AF ),  LA  voltage maps were created during sinus rhythm by external cardioversion after  PVI  and  DF  mapping. The patients were divided into  AF ‐free and  AF ‐recurrent groups.    Results  The  AF  freedom rate without antiarrhythmic drugs was 69.0% after  PVI  after 1 procedure during a 12‐month follow‐up. There was a significant difference in the  LVA  (<0.5 mV)/ LA  surface area after  PVI  between the  AF ‐free and  AF ‐recurrent groups (15% vs 23%,  P  = .033).  AF  freedom was significantly greater in those with  LVA s of ≤24% than in those with  LVA s of >24% during 12 months of follow‐up (78.6% vs 53.8%, Log‐rank test  P  = .020). Fifty‐six (72%) of the 78 high‐ DF  sites (≥8 Hz) overlapped with  LVA s. Thirty‐one (55%) of 56 high‐ DF  sites overlapped with  LVA s that existed at  LVA  border zones. There were no significant differences in number of high‐ DF  sites that overlapped with  LVA s in the  LA  between the two groups. However, in persistent  AF  patients, the max‐ DF  value in the  LA  exhibited a significant difference between the two groups ( P  = .008).    Conclusions   LVA s were associated with  AF  recurrences after  PVI  in nonparoxysmal  AF  patients and overlapped with many high‐ DF  sites.  PVI  alone may be enough to treat patients with mild‐to‐moderate extent (≤24%) of  LVA s.

journal of arrhythmia

Evaluation of the atrial substrate based on low‐voltage areas and dominant frequencies after pulmonary vein isolation in nonparoxysmal atrial fibrillation