Empirical superior vena cava isolation in addition to pulmonary vein re-isolation did not significantly improve freedom from atrial fibrillation compared to pulmonary vein isolation alone (73% vs 80%, p=0.151).
Cohort (n=344)
Yes
Does empirical superior vena cava isolation in addition to pulmonary vein re-isolation reduce the recurrence of atrial fibrillation in patients undergoing repeat ablation?
Empirical isolation of the superior vena cava during repeat ablation for recurrent atrial fibrillation does not improve arrhythmia-free survival compared to pulmonary vein re-isolation alone.
Absolute Event Rate: 73% vs 80%
p-value: p=0.151
BACKGROUND: Non-pulmonary vein (PV) triggers play a role in the initiation of atrial fibrillation (AF), with the superior vena cava (SVC) being a common location. The aim of the current study was to investigate a strategy of empirical SVC isolation (SVCI) in addition to re-isolation of PV in patients with recurrence of AF after index PV isolation (PVI). METHODS: We retrospectively analyzed consecutive patients from two centers with recurrence of AF after index PVI, undergoing a repeat ablation. Whereas only a re-isolation of the PV was intended in patients with reconnections of equal or more than two PV (PVI group), an additional SVCI was aimed for in patients with < 2 isolated PV in addition to the re-isolation of the PV (PVI + group). Analysis was performed as-treated and per-protocol. RESULTS: Of the 344 patients included in the study (age 60 ± 10 years, 73% male, 66% paroxysmal AF), PVI only was performed in 269 patients (77%) and PVI plus SVCI (PVI +) in 75 patients (23%). Overall, freedom from AF/AT after repeat PVI was 80% (196 patients) in the PVI group and 73% in the PVI + group (p = 0.151). In multivariable Cox regression analysis, presence of persistent AF (HR 2.067 (95% CI 1.389-3.078), p < 0.001) and hypertension (HR 1.905 (95% CI 1.218-2.980), p = 0.005) were identified as only significant predictors of AF/AT recurrence. The per-protocol results did not differ from this observation. CONCLUSIONS: A strategy of an empirical additional SVCI at repeat PVI ablation for recurrence of AF/AT does not improve outcome compared to a PVI only approach.
Knecht et al. (Thu,) conducted a cohort in Recurrence of atrial fibrillation after pulmonary vein isolation (n=344). Empirical superior vena cava isolation (SVCI) plus pulmonary vein re-isolation vs. Pulmonary vein re-isolation (PVI) only was evaluated on Freedom from atrial fibrillation or atrial tachycardia (AF/AT) (p=0.151). Empirical superior vena cava isolation in addition to pulmonary vein re-isolation did not significantly improve freedom from atrial fibrillation compared to pulmonary vein isolation alone (73% vs 80%, p=0.151).