Persistence of Low‐Voltage Area in the Superior Vena Cava Following Pulsed‐Field Ablation for Pulmonary Vein Isolation: Findings During Repeat Procedure

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.