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

Knecht, Sven; Zeljković, Ivan; Badertscher, Patrick; Krisai, Philipp; Spies, Florian; Vognstrup, Jan; Pavlović, Nikola; Manola, Šime; Oßwald, Stefan; Kühne, Michael; Sticherling, Christian

doi:10.1007/s10840-022-01314-w

Cited by 11 publications

(5 citation statements)

References 23 publications

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“…Non-pulmonary vein triggers play a role in the initiation of atrial fibrillation [1,2]. In our case, when the Pentaray electrode was sent to the superior vena cava, the arrhythmia should have been atrial fibrillation for the completely unequal AA interval, and the various potential amplitudes and the potential period should have been less than 250 ms.…”

Section: Discussionmentioning

confidence: 71%

Termination of Recurrent Atrial Fibrillation by Superior Vena Cava Isolation: A Case Report

Yin¹,

Wang²,

Li³

et al. 2022

CVIA

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Background: Paroxysmal atrial fibrillation can be triggered by non-pulmonary vein foci, such as the superior venacava. Here, we report the case of a patient with a 6-year history of paroxysmal atrial fibrillation who received cryoballoon ablation in 2012 but relapsed in 2014. He then received cardiac radiofrequency ablation, which successfully isolated the left pulmonary vein and superior vena cava, but the arrhythmia recently relapsed again. The tachycardia wasfinally successfully terminated by ablation on the free wall without recurrence during a 2-year following up.Conclusion: Superior vena cava isolation may not require ablation isolation with a full circle way and can be ccomplishedby ablating several connection points between the superior vena cava and the right atrium.

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Section: Discussionmentioning

confidence: 71%

Termination of Recurrent Atrial Fibrillation by Superior Vena Cava Isolation: A Case Report

Yin¹,

Wang²,

Li³

et al. 2022

CVIA

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“…Knecht et al compared empiric circumferential SVCI in addition to PVI (if the number of reconnected PVs during redo ablation procedure were ≤1) and found that empiric SVCI does not confer any advantage as far AF recurrences are concerned [ 36 ].…”

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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“…For patients with persistent forms of AF, it is more likely to have non-PV triggers, such as the left atrial posterior free wall [ 18 , 19 , 20 ], the left atrial appendage [ 21 ], the superior vena cava (young patients with AF had a higher incidence of only non-PV foci, mostly located here) [ 22 , 23 , 24 , 25 ], the coronary sinus [ 26 , 27 ], and the ligament of Marshall [ 28 , 29 ]. For non-PV foci patients, the isolation of them was a significant factor affecting the achievement of better clinical outcomes following AF ablation [ 30 ].…”

Section: Pathophysiology Of Atrial Fibrillationmentioning

confidence: 99%

Atrial Fibrillation and Chronic Coronary Ischemia: A Challenging Vicious Circle

Oancea,

Jigoranu,

Morariu

et al. 2023

Life

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Atrial fibrillation, the most frequent arrhythmia in clinical practice and chronic coronary syndrome, is one of the forms of coronary ischemia to have a strong dual relationship. Atrial fibrillation may accelerate atherosclerosis and may increase oxygen consumption in the myocardium, creating a mismatch between supply and demand, thus promoting the development or worsening of coronary ischemia. Chronic coronary syndrome alters the structure and function of gap junction proteins, affecting the conduction of action potential and leading to ischemic necrosis of cardiomyocytes and their replacement with fibrous tissue, in this way sustaining the focal ectopic activity in atrial myocardium. They have many risk factors in common, such as hypertension, obesity, type 2 diabetes mellitus, and dyslipidemia. It is vital for the prognosis of patients to break this vicious circle by controlling risk factors, drug therapies, of which antithrombotic therapy may sometimes be challenging in terms of prothrombotic and bleeding risk, and interventional therapies (revascularization and catheter ablation).

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

Cited by 11 publications

References 23 publications

Termination of Recurrent Atrial Fibrillation by Superior Vena Cava Isolation: A Case Report

Termination of Recurrent Atrial Fibrillation by Superior Vena Cava Isolation: A Case Report

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

Atrial Fibrillation and Chronic Coronary Ischemia: A Challenging Vicious Circle

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