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Background The efficacy of low‐voltage‐area ( LVA ) ablation has not been well determined. This study aimed to investigate the efficacy of LVA ablation in addition to pulmonary vein isolation on rhythm outcomes in patients with paroxysmal atrial fibrillation ( AF ). Methods and Results VOLCANO (Catheter Ablation Targeting Low‐Voltage Areas After Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation Patients) trial included paroxysmal AF patients undergoing initial AF ablation. Of 398 patients in whom a left atrial voltage map was obtained after pulmonary vein isolation, 336 (85%) had no LVA (group A). The remaining 62 (15%) patients with LVA s were randomly allocated to undergo LVA ablation (group B, n=30) or not (group C, n=32) in a 1:1 fashion. Primary end point was 1‐year AF ‐recurrence‐free survival rate. No adverse events related to LVA ablation occurred. Procedural (124±40 versus 95±33 minutes, P =0.003) and fluoroscopic times (29±11 versus 24±8 minutes, P =0.034) were longer in group B than group C. Patients with LVA s demonstrated lower AF ‐recurrence‐free survival rates (88%) than those without LVA (B, 57%, P <0.0001; C, 53%, P <0.0001). However, LVA ablation in addition to pulmonary vein isolation did not impact AF ‐recurrence‐free survival rate (group B versus C, P =0.67). Conclusions The presence of LVA was a strong predictor of AF recurrence after pulmonary vein isolation in patients with paroxysmal AF . However, LVA ablation had no beneficial impact on 1‐year rhythm outcomes. Registration URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000023403.

PACSS grade 4 calcification was independently associated with clinical outcomes after EVT for de novo SFA lesions.

Introduction The prevalence of atrial fibrillation (AF) increases with age. Although the efficacy of cryoballoon ablation (CB‐A) in patients with AF has been demonstrated, data on the efficacy of this CB‐A in elderly patients are limited. The aim of this study was to evaluate the 1‐year efficacy and safety of CB‐A in patients aged ≥80 years compared with those less than 80 years. Methods A total of 49 consecutive patients ≥80 years with paroxysmal AF (PAF) who underwent CB‐A were compared with 241 patients aged <80 years. AF‐free survival rate at 1 year and procedural data were compared between the groups. Results Median (25th, 75th quartile) age was 83 (82, 85) years in the older group and 68 (61, 73) years in the younger group. At 1‐year follow‐up, the success rate did not significantly differ between the groups. In Cox regression analysis, age ≥80 years was not significantly related to AF recurrence. Low‐voltage areas were more frequently observed in the elderly group than the control group (39% vs 17%; P = .01). Fluoroscopy time and procedure time did not differ significantly. There was no significant difference in the occurrence rate of transient phrenic nerve palsy. No severe complications occurred in either group, including procedure‐related deaths, atrioesophageal fistula, cardiac tamponade, and cerebrovascular embolic events. Conclusion The results of our study showed that CB‐A for PAF is a feasible and safe procedure even in elderly patients, with similar success and complication rates when compared with a younger population.

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