Ectopies from the superior vena cava after pulmonary vein isolation in patients with atrial fibrillation

Sugimura, Sousuke; Kurita, Takashi; Kaitani, Kazuaki; Yasuoka, Ryobun; Miyazaki, Shunichi

doi:10.1007/s00380-015-0767-9

Cited by 8 publications

(5 citation statements)

References 15 publications

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“…These foci may have longer effective refractory periods, making them more difficult to detect before performing a PVI. 77 Furthermore, as AF progresses, the superior vena cava’s function as the AF initiator decreases. 78 …”

Section: Catheter Ablation Strategies Beyond Pvimentioning

confidence: 99%

Catheter Ablation Approaches for the Treatment of Arrhythmia Recurrence in Patients with a Durable Pulmonary Vein Isolation

Nesapiragasan,

Hayıroğlu,

Sciacca

et al. 2023

Balkan Med J

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Catheter ablation has emerged as an effective treatment for atrial arrhythmias, and pulmonary vein isolation (PVI) is the cornerstone of ablation strategies. Significant technological evolution and widespread increase in operator experience have facilitated the effectiveness of catheter ablation to achieve durable PVIs in single or multiple ablation procedures. Nevertheless, arrhythmia recurrence is a common problem even after establishing PVI. Data on catheter ablation in these patients are sparse and repeat ablation in this population is highly challenging. In this review we have summarized the available data as well as potential strategies of catheter ablation following the initial PVI.

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Section: Catheter Ablation Strategies Beyond Pvimentioning

confidence: 99%

Catheter Ablation Approaches for the Treatment of Arrhythmia Recurrence in Patients with a Durable Pulmonary Vein Isolation

Nesapiragasan,

Hayıroğlu,

Sciacca

et al. 2023

Balkan Med J

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“…It is important to note that SVC ectopies may only become detectable after elimination of predominant PV foci. Testing for SVC arrhythmogenicity is therefore recommended after PV isolation.…”

Section: Editorial Commentmentioning

confidence: 99%

Phrenic Nerve Injury During Isolation of the Superior Vena Cava: Prevention Using Diaphragmatic Compound Motor Action Potentials – “Primum Nil Nocere.”

Deneke

Mügge

Nentwich

et al. 2016

Cardiovasc electrophysiol

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atrial fibrillation, catheter ablation, phrenic nerve injury, superior vena cava Editorial CommentPhrenic nerve injury (PNI) is a major complication of cardiac ablation procedures leading to paralysis of the diaphragm. Anectodal reports on PNI after ablation of left-sided accessory pathways, right-sided atrial tachycardias, and epicardial ablation of ventricular tachycardias exist, but it is more common in atrial fibrillation (AF) ablation. PNI is rare after isolation of the right-sided (mostly superior) pulmonary vein (PV) (up to 0.48%) 1 or isolation of the superior vena cava (SVC) (2.1%) 2 using radiofrequency energy. In contrast, it has been documented in up to 20% of PV isolation procedures in highly experienced centers using the cryoballoon generation 1 and 2, making this the most common complication among all AF ablation technologies. 3,4 The high incidence of PNI during cryo-PV isolation is related to the specifications of the ablation balloon and the proximity of the PN to the right superior PV. Although approximately 80% of PNI resolve this, it may take as long as 15 months and symptoms may be disabling and worse than AF-related impairment. 2,5Transient PNI occurs earlier (at lower temperatures during heating and potentially higher temperatures during cooling) than persistent PNI enabling use of prophylactic sensitive screening with CMAP monitoring during ablation at critical sites with the potential for prompt restitution of normal diaphragm motility. Therefore, the field of prevention has prompted scientific evaluations in recent years.Whereas careful observation of the diaphragm motion on fluoroscopy during isolation of the right superior PV during spontaneous breathing or pacing of the right-sided PN may detect relevant paralysis early, detection of impaired diaphragm contraction may become identified only when using diaphragm electromyography as a surrogate parameter of PN function. First described in 1967, recordings of compound motor action potentials (CMAP) of the diaphragm were later regularly used to gather information on PN function in patients with neuromuscular diseases.9 Monitoring CMAP as a surrogate for right PN function during AF ablation was initially applied in 2011 10 and since then has gained wide acceptance as surveillance of PNI during cryo-PV isolation. 11CMAP can easily be obtained using two additional surface ECG electrodes positioned approximately 5 cm above the xiphoid and 16 cm along the right costal margin as optimal positions.12 Ideal sites of recording are not confined to these sites but especially a recording site cm away from the 16 cm point along the costal margin may be used, making this technology easy to use and reduce potential recording errors. During pacing of the right PN superior to the attempted ablation area diaphragm, CMAPs are recorded via these two patch-electrodes and displayed on a regular electrophysiology recording system. During ablation the amplitude of the CMAP is observed and a decrease of CMAP is used as an indicator for impeding PNI. Animal studi...

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“…SVC foci are usually going unnoticed in the electrophysiology lab, unless several provocative maneuvers (AF cardioversion, adenosine triphosphate and/or isoproterenol (ISP) infusion) are undertaken [ 9 , 23 ]. What is more, SVC foci might feature longer effective refractory intervals and thus can only be revealed after PVI [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy, Safety and Feasibility of Superior Vena Cava Isolation in Patients Undergoing Atrial Fibrillation Catheter Ablation: An Up-to-Date Review

et al. 2023

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Pulmonary vein isolation (PVI) is the cornerstone in atrial fibrillation (AF) ablation; yet, the role of arrhythmogenic superior vena cava (SVC) is increasingly recognized and different ablation strategies have been employed in this context. SVC can act as a trigger or perpetuator of AF, and its significance might be more pronounced in patients undergoing repeated ablation. Several cohorts have examined efficacy, safety and feasibility of SVC isolation (SVCI) among AF patients. The majority of these studies explored as-needed SVCI during index PVI, and only a minority of them included repeated ablation subjects and non-radiofrequency energy sources. Studies of heterogeneous design and intent have explored both empiric and as-needed SVCI on top of PVI and reported inconclusive results. These studies have largely failed to demonstrate any clinical benefit in terms of arrhythmia recurrence, although safety and feasibility are undisputable. Mixed population demographics, small number of enrollees and short follow-up are the main limitations. Procedural and safety data are comparable between empiric SVCI and as-needed SVCI, and some studies suggested that empiric SVCI might be associated with reduced AF recurrences in paroxysmal AF patients. Currently, no study has compared different ablation energy sources in the setting of SVCI, and no randomized study has addressed as-needed SVCI on top of PVI. Furthermore, data regarding cryoablation are still in their infancy, and regarding SVCI in patients with cardiac devices more safety and feasibility data are needed. PVI non-responders, patients undergoing repeated ablation and patients with long SVC sleeves could be potential candidates for SVCI, especially via an empiric approach. Although many technical aspects remain unsettled, the major question to answer is which clinical phenotype of AF patients might benefit from SVCI?

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Ectopies from the superior vena cava after pulmonary vein isolation in patients with atrial fibrillation

Cited by 8 publications

References 15 publications

Catheter Ablation Approaches for the Treatment of Arrhythmia Recurrence in Patients with a Durable Pulmonary Vein Isolation

Catheter Ablation Approaches for the Treatment of Arrhythmia Recurrence in Patients with a Durable Pulmonary Vein Isolation

Phrenic Nerve Injury During Isolation of the Superior Vena Cava: Prevention Using Diaphragmatic Compound Motor Action Potentials – “Primum Nil Nocere.”

Efficacy, Safety and Feasibility of Superior Vena Cava Isolation in Patients Undergoing Atrial Fibrillation Catheter Ablation: An Up-to-Date Review

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