Key result
Adding SVC isolation to cryoballoon PVI yields no rhythm benefit but causes 40% phrenic nerve palsy.
Why the study?
To evaluate the impact and safety of supplementing cryoballoon pulmonary vein isolation with superior vena cava isolation in patients with persistent AF.
Does cryoballoon pulmonary vein isolation supplemented by superior vena cava isolation improve efficacy or safety compared to standard pulmonary vein isolation alone in patients with persistent atrial fibrillation?
RCT (n=40)
No
Does cryoballoon pulmonary vein isolation supplemented by superior vena cava isolation improve efficacy or safety compared to standard pulmonary vein isolation alone in patients with persistent atrial fibrillation?
Adding superior vena cava isolation to standard cryoballoon pulmonary vein isolation for persistent atrial fibrillation does not improve rhythm control but significantly increases the risk of persistent phrenic nerve palsy.
Answers are grounded in this paper and cite their sources.
Should not add superior vena cava isolation to cryoballoon pulmonary vein isolation; challenges adjunctive ablation benefit in persistent atrial fibrillation.
Aim . To study the impact and safety of cryoballoon ablation of the pulmonary vein (PV), supplemented by isolation of the superior vena cava in patients with persistent atrial fibrillation (AF). Methods . The study is single-center, randomized, prospective. The total number of patients was 40. All of them underwent cryoballoon isolation of the PV for persistent AF. The patients were then divided into two groups: the first group included patients who underwent the standard procedure, and the second group included patients with the standard procedure supplemented by isolation of the superior vena cava. Patients in both groups had similar anatomical and clinical-anamnestic parameters. The duration of the surgical intervention was not statistically different. Results . The average follow-up period was 354±19 days. In the group of classical cryoballoon PV isolation, after 12 months of observation without antiarrhythmic therapy, sinus rhythm was maintained in 40% of patients (8 people), in the group of extended cryoballoon PV isolation - in the same number of patients (40%, P=1). In the PV isolation group, persistent phrenic nerve palsy was observed in no patients, and in the extended ablation group, in eight patients (40%, P=0.0016). At the end of the observation, no remote complications were registered. Conclusions . In patients with persistent AF, cryoballoon PV isolation supplemented by superior vena cava isolation is a less safe technique than standard cryoballoon pulmonary vein isolation, with comparable efficacy.
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Livadnyi et al. (2025) conducted an RCT in Persistent atrial fibrillation (n=40). Cryoballoon pulmonary vein isolation supplemented by superior vena cava isolation vs. Standard cryoballoon pulmonary vein isolation alone was evaluated on Maintenance of sinus rhythm at 12 months without antiarrhythmic therapy (p=1). Adding superior vena cava isolation to cryoballoon pulmonary vein ablation yielded similar sinus rhythm maintenance but increased phrenic nerve palsy.
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