Comparison between superior vena cava ablation in addition to pulmonary vein isolation and standard pulmonary vein isolation in patients with paroxysmal atrial fibrillation with the cryoballoon technique

Abstract

Background Paroxysmal atrial fibrillation (PAF) can be triggered by non-pulmonary vein foci, like the superior vena cava (SVC). The latter is correlated with improved result in terms of freedom from atrial tachycardias (ATs), when electrical isolation of this vessel utilizing radiofrequency energy (RF) is achieved. Objectives Evaluate the clinical impact, in patients with PAF, of the SVC isolation (SVCi) in addition to ordinary pulmonary vein isolation (PVI) by means of the second-generation cryoballoon (CB) Methods A total of 100 consecutive patients that underwent CB ablation for PAF were retrospectively selected. Fifty consecutive patients received PVI followed by SVCi by CB application, and the following 50 consecutive patients received standard PVI. All patients were followed 12 months. Results The mean time to SVCi was 36.7 ± 29.0 s and temperature at SVC isolation was − 35 (− 18 to − 40) °C. Real-time recording (RTR) during SVCi was observed in 42 (84.0%) patients. At the end of 12 months of follow-up, freedom from ATs was achieved in 36 (72%) patients in the PVI only group and in 45 (90%) patients of the SVC and PV isolation group (Fisher’s exact test p = 0.039, binary logistic regression: p = 0.027, OR = 0.28, 95%CI = 0.09–0.86). In survival analysis, SVC and PV isolation group was also associated with improved freedom from ATs (log-rank test: p = 0.017, Cox regression: p = 0.026, HR = 0.31, 95%CI = 0.11–0.87). Conclusion Superior vena cava isolation with the CB in addition to PVI might improve freedom from ATs if compared to PVI alone at 1-year follow-up.

Role of empirical isolation of the superior vena cava in patients with recurrence of atrial fibrillation after pulmonary vein isolation—a multi-center analysis

“…Recently, a retrospective study by a highly experienced CB center demonstrated both the feasibility as well as a lower AF/AT recurrence when performing SCVI using the CB in patients with paroxysmal AF. However, the incidence of PNP and sinus node impairment was increased [15]. For repeat procedures in patients with AF/AT recurrence after index PVI, there currently only exists one study which investigates the value of additional SVCI on top of PVI [12].…”

Empirical superior vena cava isolation improves outcomes of radiofrequency re-ablation in pulmonary vein isolation non-responders: A 2-center retrospective study in China

“…Thus, patients with concealed non-PV triggers in the Asian population were most likely to be with SVC triggers and could benefit from empirical SVC isolation, which is in consistency with the results from other population. Additionally, unlike other non-PV triggers elimination, SVC isolation is a more commonly applied technique with exact endpoint, making the ablation results more replicable and reliable even when the non-PV triggers in uninducible., and superior vena cava isolation is proved to be safe and feasible ( 31 , 32 ). Our study demonstrated that empirical SVC isolation was the only independent predictor of recurrence after the second ablation of AF, suggesting that empirical SVC isolation improved the outcome of re-ablation in patients with all PVs isolated.…”

Contemporary Ablation Techniques for Atrial Fibrillation: An Evidence-Based Analysis

“…Cryoballoon has also been used to achieve SVCI and has improved freedom from AT in PAF subjects. (82) An empirical approach to SVCI has been investigated in a prospective, randomized study (83), which found no significant differences in maintenance of sinus rhythm without antiarrhythmic drugs . The same conclusion was derived from a meta-analysis by Sharma et al (84)including a total of 526 subjects, in which no difference in AF recurrence when SVCI was added to PVI across all types of AF.…”