Importance of the length of the myocardial sleeve in the superior vena cava in patients with atrial fibrillation

Nyuta, Eiji; Takemoto, Masao; Sakai, Togo; Mito, Taro; Masumoto, Akihiro; Todoroki, Wataru; Yagyu, Keishiro; Ueno, Jiro; Antoku, Yasunobu; Koga, Tokushi; Ueno, Takayoshi; Tsuchihashi, Takuya

doi:10.1002/joa3.12494

Cited by 11 publications

(7 citation statements)

References 18 publications

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“…Tsai et al found that SVC initiates AF in 6% of PAF patients and could be effectively and safely ablated with a mean number of five RF applications [ 3 ]. Nyuta et al suggested that SCV length greater than 37 mm and SVC diameter greater than 17 mm could be predictive of SVC foci in AF subjects undergoing PVI [ 41 ].…”

Section: Resultsmentioning

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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Section: Resultsmentioning

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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“…This was further supported by the non-induction of the SVC firing and/or AF initiation by an intravenous administration of isoproterenol (5 μ g) and adenosine triphosphate (30 mg). 9 …”

Section: Discussionmentioning

confidence: 99%

“…Therefore, repeated bolus injections of isoproterenol (5 μ g) did not induce extra PV triggers and/or AF initiation. Moreover, intravenous administration of isoproterenol (5 μ g) and adenosine triphosphate (30 mg) 9 did not induce SVC firing and/or AF initiation. During a 30 min observation period, no recurrence of PV-to-atrium conduction was observed.…”

Section: Case Reportmentioning

confidence: 92%

Epicardial connection(s) inside the pulmonary vein antrum isolation lines contribute to subsequent atrial fibrillation: a case report

Fujiwara

Takemoto

Koga

et al. 2023

European Heart Journal - Case Reports

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Background Recent reports have demonstrated that approximately 10% of patients with atrial fibrillation (AF) have epicardial connections (ECs) inside the pulmonary vein (PV) antrum isolation (AI) (PVAI) lines, which could be a possible mechanism of failure to achieve a complete PVAI, thus contributing to AF recurrence. Case summary We present an 80-year-old female case with consistently continuing AF associated with ECs. ECs involving the PVs were detected in the left and right superior PVs after the completion of the PVAI. The AF steadily terminated after the ablation of those ECs. She has remained well without any AF or symptoms for 2-years post-ablation. Discussion Those ECs might have played a possible important role in initiating and maintaining the AF. The mechanism(s) of the ECs may be a cornerstone of the failure to achieve a complete PVAI contributing to AF recurrence. Ablation of the EC(s) in addition to the PVAI may be better able to achieve the completion of the PVAI. Thus, physicians should be aware of the possibility of the presence of EC(s) when performing ablation of AF, even though complete PVAI lines have been achieved.

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“…A previous study reported that SVC firing is more likely to occur in patients with long SVC sleeves (>37 mm) or long SVC diameters (>17 mm) 19 . Our study also revealed that the longer diameter of the SVC was significantly longer in the SIG (27.4±4.3 vs. 22.9±4.6 mm, p=0.03) compared to that of the non-SIG.…”

Section: Factors Related To Af Originating From the Svcmentioning

confidence: 95%

“…In a report on clinical features, SVC-AF tends to be more common in female patients, those with a lower body mass index, and those with certain genes (rs2634073 and rs6584555) 18 . The electrical characteristics were that SVC-AF is more common in patients with long SVC sleeves (>30 mm 12,13 ), SVC firing is more likely to occur in patients with long SVC sleeves (>37 mm) or long SVC diameters (>17 mm) 19 , and SVC-AF is more common in cases with a large potential (>1 mv 12 ).…”

Section: Factors Related To Af Originating From the Svcmentioning

confidence: 99%

Relationship between effective refractory period and inducibility of atrial fibrillation from the superior vena cava after pulmonary vein isolation

Yamagishi

Oginosawa²,

Fujino

et al. 2021

Preprint

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Background: In terms of the pulmonary vein (PV), atrial fibrillation (AF) patients have a shorter effective refractory period (ERP) and a larger dispersion of the ERP than patients without AF. Although the frequency of AF from the superior vena cava (SVC) was the highest among non-PV foci, the characteristics of the ERP in the SVC (SVC-ERP) were unclear. The purpose of this study was to elucidate the relationship between SVC-ERP and the inducibility of AF after pulmonary vein isolation (PVI). Methods and Results: Consecutive 28 patients who underwent PVI were included. After successful PVI, the SVC-ERP was measured at three positions in SVC. Rapid electrical stimuli were delivered at the shortest SVC-ERP to induce AF. Patients in whom AF was induced were assigned to the SVC-induced group (SIG) and the remaining patients were the non-SVC-induced group (non-SIG). The size of the SVC sleeve was evaluated using three-dimensional electroanatomic mapping. The SIG had a significantly shorter average SVC-ERP (236.0±25.2 vs. 294.8±36.8 ms, p<0.001), while SVC-ERP dispersion was not significantly different (30.0±25.4 vs. 33.3±20.1 ms, p=0.56). Although the longer SVC diameter was significantly longer in the SIG (27.4±4.3 vs. 22.9±4.6 mm, p=0.03), the SVC-ERP was significantly associated with pacing inducibility of AF after adjustment for the longer SVC diameter (odds ratio: 0.96 [1-ms increments], p=0.01). Conclusions: The SIG had a shorter SVC-ERP, while the dispersion was not significantly different between the two groups. The SVC-ERP can be one of the mechanisms of arrhythmogenicity for AF originating from the SVC.

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Importance of the length of the myocardial sleeve in the superior vena cava in patients with atrial fibrillation

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 11 publications

References 18 publications

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

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

Epicardial connection(s) inside the pulmonary vein antrum isolation lines contribute to subsequent atrial fibrillation: a case report

Relationship between effective refractory period and inducibility of atrial fibrillation from the superior vena cava after pulmonary vein isolation

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