| Summary: | Background: Age has been found as an important factor affecting the low voltage area (LVA) in patients with atrial fibrillation (AF). This study aims to investigate the potential benefit of LVA modification in older AF patients. Methods: This study constitutes a sub‐analysis of the STABLE‐SR‐II and STABLE‐SR‐III trials, wherein patients with persistent AF (PeAF) or paroxysmal AF (PAF) were randomized to undergo either circumferential pulmonary vein isolation (CPVI) alone or additional LVA modification. Patients aged ≥65 years were analyzed. The primary outcome was freedom from atrial tachyarrhythmias (ATAs). Results: A total of 510 patients (mean age 70.2 ± 3.8 years, 264 male) were analyzed, comprising 96 PeAF and 414 PAF patients. Among patients without LVA, the risk of ATAs recurrence was similar between PeAF and PAF patients in the propensity score‐matched model (adjusted HR, 1.49 [0.54–4.33]; p = 0.431). Both PeAF (adjusted HR, 0.35 [95% CI, 0.12–0.98]; p = 0.048) and PAF patients (adjusted HR, 0.41 [0.19–0.81]; p = 0.013) could benefit from additional LVA modification in the Cox proportional hazards model. Conclusions: In older patients with AF, the recurrence rate following CPVI alone is comparable between those with PAF and PeAF in the absence of LVA. However, the presence of LVA is associated with higher recurrence rates in both PAF and PeAF patients, while additional LVA modification effectively reduces recurrence irrespective of AF type.
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