Superior vena cava low-voltage areas persisted in 65% of patients at repeat procedure after pulsed-field ablation, associated with shorter SVC-RSPV distance (3.2 vs. 5.1 mm, p=0.013).
Observational (n=25)
Does low-voltage area in the superior vena cava persist following pulsed-field ablation for pulmonary vein isolation in patients with atrial fibrillation?
Low-voltage areas in the superior vena cava frequently persist after pulsed-field ablation for pulmonary vein isolation, especially when the SVC and right superior pulmonary vein are in close proximity, potentially facilitating atrial tachyarrhythmias.
ABSTRACT Introduction Superior vena cava (SVC) conduction delay or isolation can occur during right superior pulmonary vein (RSPV) ablation using pulsed‐field ablation (PFA). However, the persistence of these abnormalities and their clinical associations with atrial tachyarrhythmias remain unclear. Herein, we assessed the persistence of low‐voltage area (LVA) within SVCs, initially identified following the index procedure, and their associations with atrial tachyarrhythmias documented at repeat intervention across 25 patients with atrial fibrillation (AF) who underwent a repeat procedure after pulmonary vein isolation (PVI) using PFA. Methods and Results A de novo SVC LVA occurred in 20 of 25 patients (80%) after the index procedure. At the repeat procedures, performed after a median of 155 days, SVC LVA persisted in 13 of 20 patients (65%). Patients with persistent SVC LVA exhibited a shorter SVC–RSPV distance on preprocedural computed tomography than those without persistence (3.2 vs. 5.1 mm, p = 0.013). Residual LVA in the SVC was associated with colocalization with an atrial tachycardia isthmus in one patient and SVC‐triggered AF in another. Conclusion SVC LVA after PVI using PFA frequent occurred and persisted in approximately two‐thirds of the patients, particularly when SVC and RSPV proximity was close. PFA‐related collateral effects may facilitate atrial tachyarrhythmias.
Matsuura et al. (Sat,) conducted a observational in Atrial fibrillation (n=25). Pulsed-field ablation (PFA) was evaluated on Persistence of low-voltage area (LVA) within SVCs at repeat procedure. Superior vena cava low-voltage areas persisted in 65% of patients at repeat procedure after pulsed-field ablation, associated with shorter SVC-RSPV distance (3.2 vs. 5.1 mm, p=0.013).