Structural relation between the superior vena cava and pulmonary veins in patients with atrial fibrillation

Yoshida, Kentaro; Baba, Masakazu; Hasebe, Hideyuki; Shinoda, Yasutoshi; Harunari, Tomohiko; Ebine, Mari; Uehara, Yoshiko; Watabe, Hiroaki; Takeyasu, Noriyuki; Horigome, Hitoshi; Nogami, Akihiko; Ieda, Masaki

doi:10.1007/s00380-019-01431-z

Cited by 8 publications

(7 citation statements)

References 16 publications

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“…One of the mechanisms is the SVC arrhythmogenicity, which is one of the main sources of non-pulmonary vein ectopies that initiate AF. Although there are studies that investigate the electrical properties of SVC, impact of SVC isolation in addition to PVI, and its correlation to AFR after ablation, there are no studies focusing on the SVC anatomy and enlargement as a risk factor of AFR after PVI [29] , [30] . Our study found no correlation between SVC ostium surface area and AFR after PVI.…”

Section: Discussionmentioning

confidence: 99%

Atrial appendages’ mechanics assessed by 3D transoesophageal echocardiography as predictors of atrial fibrillation recurrence after pulmonary vein isolation

Zeljković

Bulj

Kordić

et al. 2020

IJC Heart & Vasculature

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Highlights Data on atrial appendages' mechanics as predictors of AF recurrence after PVI is scarce. 3D and 2D-TEE have potential to provide additional data on LAA function. Patients with AFR had significantly lower LAA tissue velocity and ostium surface area. RAA tissue velocity and SVC ostium surface area were not correlated to AF recurrence.

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Section: Discussionmentioning

confidence: 99%

Atrial appendages’ mechanics assessed by 3D transoesophageal echocardiography as predictors of atrial fibrillation recurrence after pulmonary vein isolation

Zeljković

Bulj

Kordić

et al. 2020

IJC Heart & Vasculature

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“…Thereafter, a cavotricuspid isthmus line was created, with an endpoint of bidirectional conduction block [ 7 ]. If non-PV ectopies were reproducibly observed with and without the continuous infusion of isoproterenol (1–4 mcg/min), they were targeted for ablation [ 13 , 14 , 15 , 16 , 17 ]. Neither ablation of continuous fractionated atrial electrograms nor left atrial linear ablation was performed in this series in the index procedures.…”

Section: Methodsmentioning

confidence: 99%

Predictors of Recurrence after Catheter Ablation of Paroxysmal Atrial Fibrillation in Different Follow-Up Periods

et al. 2020

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Background and objectives: Pulmonary vein (PV) reconnection is a major reason for recurrence after catheter ablation of paroxysmal atrial fibrillation (PAF). However, the timing of the recurrence varies between patients, and recurrence >1 year after ablation is not uncommon. We sought to elucidate the characteristics of atrial fibrillation (AF) that recurred in different follow-up periods. Materials and Methods: Study subjects comprised 151 consecutive patients undergoing initial catheter ablation of PAF. Left atrial volume index (LAVi) and atrial/brain natriuretic peptide (ANP/BNP) levels were systematically measured annually over 3 years until AF recurred. Results: Study subjects were classified into four groups: non-recurrence group (n = 84), and short-term- (within 1 year) (n = 30), mid-term- (1–3 years) (n = 26), and long-term-recurrence group (>3 years) (n = 11). The short-term-recurrence group was characterized by a higher prevalence of diabetes mellitus (hazard ratio 2.639 (95% confidence interval, 1.174–5.932), p = 0.019 by the Cox method), frequent AF episodes (≥1/week) before ablation (4.038 (1.545–10.557), p = 0.004), and higher BNP level at baseline (per 10 pg/mL) (1.054 (1.029–1.081), p < 0.0001). The mid-term-recurrence group was associated with higher BNP level (1.163 (1.070–1.265), p = 0.0004), larger LAVi (mL/m2) (1.033 (1.007–1.060), p = 0.013), and longer AF cycle length at baseline (per 10 ms) (1.194 (1.058–1.348), p = 0.004). In the long-term-recurrence group, the ANP and BNP levels were low throughout follow-up, as with those in the non-recurrence group, and AF cycle length was shorter (0.694 (0.522–0.924), p = 0.012) than those in the other recurrence groups. Conclusions: Distinct characteristics of AF were found according to the time to first recurrence after PAF ablation. The presence of secondary factors beyond PV reconnections could be considered as mechanisms for the recurrence of PAF in each follow-up period.

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“…’’The increasing implementation of CBA and contact force RFA might lead to an era of reduced PV reconnection and the number of the so-called PVI non responders necessitating specialized treatment during redo ablation will increase [ 55 ]. Besides PVI non-responders, patients undergoing repeated CBA procedures [ 54 ] and patients with long SVC sleeves [ 26 , 41 ] or arrhythmogenic RSPV [ 22 , 34 ] could be optimal candidates for SVCI, especially via an empiric approach.…”

Section: Summary and Perspectivesmentioning

confidence: 99%

“…SVC sleeves are mainly present on the endocardial side, featuring both increased automaticity and triggered activity, whereas PV sleeves are predominantly epicardial, featuring triggered activity [ 20 , 21 ]. Of note, SVC and right superior PV (RSPV) sleeve length and arrhythmogenicity are positively correlated [ 22 ].…”

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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Structural relation between the superior vena cava and pulmonary veins in patients with atrial fibrillation

Cited by 8 publications

References 16 publications

Atrial appendages’ mechanics assessed by 3D transoesophageal echocardiography as predictors of atrial fibrillation recurrence after pulmonary vein isolation

Atrial appendages’ mechanics assessed by 3D transoesophageal echocardiography as predictors of atrial fibrillation recurrence after pulmonary vein isolation

Predictors of Recurrence after Catheter Ablation of Paroxysmal Atrial Fibrillation in Different Follow-Up Periods

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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