Key result
The SVC crescent sign (OR 8.88; 95% CI 3.21-24.60) and larger right atrial volume were independent predictors of superior vena cava foci initiating atrial fibrillation.
Why the study?
Predicting the presence of SVC foci before catheter ablation helps guide ablation strategy for SVC isolation, but structural characteristics of patients with these foci needed clarification.
What are the structural characteristics on cardiac computed tomography that predict the presence of superior vena cava (SVC) foci initiating atrial fibrillation?
Observational (n=331)
What are the structural characteristics on cardiac computed tomography that predict the presence of superior vena cava (SVC) foci initiating atrial fibrillation?
Answers are grounded in this paper and cite their sources.
The presence of an SVC crescent sign and larger right atrial volume on pre-procedural CT independently predict SVC foci initiating atrial fibrillation, which may help guide ablation strategies.
INTRODUCTION: The superior vena cava (SVC) is the most common source of non-pulmonary vein foci in atrial fibrillation (AF); therefore, predicting the existence of non-pulmonary vein foci before the catheter ablation procedure helps construct a proper ablation strategy in preparation for SVC isolation. This study aimed to clarify the structural characteristics of patients with SVC foci initiating AF. METHODS: We enrolled 331 consecutive patients with AF who underwent cardiac computed tomography imaging before radiofrequency catheter ablation treatment, and they were divided into SVC (+) and (-) groups based on the presence or absence of SVC foci initiating AF. RESULTS: The SVC (+) group (n = 27) exhibited SVC crescent signs-defined as a curve-shaped SVC with two narrow pointed ends-more frequently (37% vs. 9%, p < .001), and larger right atrial volume (95.6 ± 20.8 vs. 80.5 ± 26.1 mL, p = .004) than the SVC (-) group (n = 304). Multivariate logistic regression analysis revealed that the SVC crescent sign (odds ratio, 8.88; 95% confidence interval [CI], 3.21-24.60) and right atrial volume (odds ratio, 1.03; 95% CI, 1.01-1.04) were independent predictors of SVC foci. CONCLUSION: Patients with SVC foci exhibited more frequent SVC crescent signs and larger right atrial volumes, and these characteristics may help clinicians choose the appropriate ablation technology.
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Oka et al. (2023) conducted an observational in Atrial fibrillation (n=331). Presence of superior vena cava (SVC) foci vs. Absence of SVC foci was evaluated on Presence of SVC crescent sign (OR 8.88, 95% CI 3.21-24.60, p=<.001). The SVC crescent sign (OR 8.88; 95% CI 3.21-24.60) and larger right atrial volume were independent predictors of superior vena cava foci initiating atrial fibrillation.
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