Catheter ablation for paroxysmal AF originating from the superior vena cava achieved a 73.3% freedom-from-AF rate at 5 years, with higher recurrence in patients with both SVC and PV triggers (P=0.012).
Cohort (n=68)
Does catheter ablation prevent AF recurrence in patients with drug-refractory, symptomatic paroxysmal AF originating from the superior vena cava?
Catheter ablation provides long-term freedom from AF in 73% of patients with paroxysmal AF originating from the SVC at 5 years, with SVC isolation alone being an effective strategy for those without PV triggers.
p-value: p=0.012
UNLABELLED: Long-Term Outcome of SVC AF Ablation. INTRODUCTION: Data of the long-term clinical outcome after superior vena cava (SVC) isolation are limited. We aimed to evaluate the long-term outcome in patients with atrial fibrillation (AF) who had triggers originating from the SVC and received catheter ablation of AF. METHODS AND RESULTS: The study consisted of 68 patients (age 56 ± 12 years old, 32 males) who underwent the ablation procedure for drug-refractory, symptomatic paroxysmal AF originating from the SVC since 1999. Group 1 consisted of 37 patients with AF initiated from the SVC only, and group 2 consisted of 31 patients with both SVC and pulmonary vein (PV) triggers. During a follow-up period of 88 ± 50 months, the AF recurrence rate was 35.3% after a single procedure. The freedom-from-AF rates were 85.3% at 1 year and 73.3% at 5 years. In the baseline study, group 2 had larger left atrium (38 ± 4 mm vs 36 ± 5 mm, P = 0.04), left ventricle (50 ± 5 mm vs 46 ± 5 mm, P = 0.003), and PV diameters. Kaplan-Meier survival analysis showed a higher AF recurrence rate in group 2 compared to that in group 1 (P = 0.012). The independent predictor of an AF recurrence was a larger SVC diameter (P = 0.02, HR 1.4, 95% CI 1.1-1.8). CONCLUSION: Among the patients with paroxysmal AF originating from the SVC, 73% remained free of AF for 5 years after a single catheter ablation procedure. Superior vena cava isolation without PV isolation is an acceptable therapeutic strategy in those patients with AF originating from the SVC only. The SVC diameter was an independent predictor of AF recurrence. (J Cardiovasc Electrophysiol, Vol. 23, pp. 955-961, September 2012).
Chang et al. (jeu,) ont mené une cohorte sur la fibrillation auriculaire provenant de la veine cave supérieure (n=68). L'ablation par cathéter par rapport aux déclencheurs de SVC et de PV (Groupe 2) par rapport aux déclencheurs de SVC seulement (Groupe 1) a été évaluée sur la récidive de FA (p=0.012). L'ablation par cathéter pour la FA paroxystique provenant de la veine cave supérieure a atteint un taux de liberté de 73,3 % sans FA à 5 ans, avec une récidive plus élevée chez les patients ayant des déclencheurs à la fois de SVC et de PV (P=0.012).