Empiric superior vena cava isolation in addition to pulmonary vein isolation significantly reduced atrial fibrillation recurrence by 46% (OR 0.54) compared to pulmonary vein isolation alone in patients with paroxysmal atrial fibrillation.
Meta-Analysis (n=600)
Does the addition of empiric superior vena cava isolation to pulmonary vein isolation reduce AF recurrence in patients with atrial fibrillation?
Empiric superior vena cava isolation added to pulmonary vein isolation significantly reduces atrial fibrillation recurrence in patients with paroxysmal AF without increasing complications or procedural times.
Effect estimate: OR 0.54 (95% CI 0.32-0.92)
Absolute Event Rate: 11.7% vs 19.9%
p-value: p=0.02
Abstract Background The long-term success rate of pulmonary vein isolation (PVI) is suboptimal due to the presence of non-pulmonary vein (PV) foci that can trigger atrial fibrillation (AF) in up to 11%. Among non-PV triggers, the superior vena cava (SVC) is a major site of origin of ectopic beats initiating AF. Objective To compare data from randomized controlled trials (RCTs) assessing PVI + empiric SVC isolation (SVCI) versus PVI alone in terms of AF recurrence, procedure-related complications, and fluoroscopic and procedural times. Methods A search of online scientific libraries (from inception to April 1, 2024) was performed. Four RCTs were considered eligible for the meta-analysis totaling 600 patients of whom 287 receiving PVI + SVCI and 313 receiving PVI alone. Results In the overall population, SVCI + PVI was associated with a non-significant reduction of AF recurrence at follow-up (0.66 0.43;1.00, p = 0.05, I 2 0%). In patients with paroxysmal AF (PAF), a significant reduction of AF recurrence was related to SVCI + PVI (11.7%) as compared to PVI alone (19.9%) (0.54 0.32;0.92, p = 0.02, I 2 0%). No statistical differences were found among the groups in terms of fluoroscopic (3.31 − 0.8;7.41, p = 0.11, I 2 = 91%), procedural times (5.69 − 9.78;21.16, p = 0.47, I 2 = 81%), and complications (1.06 0.33;3.44, p = 0.92, I 2 = 0%). Conclusion The addition of SVCI to PVI in patients in PAF is associated with a significant lower rate of AF recurrence at follow-up, without increasing complication rates and procedural and fluoroscopy times. Graphical Abstract
Mariani et al. (Fri,) conducted a meta-analysis in Paroxysmal atrial fibrillation (n=600). Pulmonary vein isolation + empiric superior vena cava isolation vs. Pulmonary vein isolation alone was evaluated on Atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation (OR 0.54, 95% CI 0.32-0.92, p=0.02). Empiric superior vena cava isolation in addition to pulmonary vein isolation significantly reduced atrial fibrillation recurrence by 46% (OR 0.54) compared to pulmonary vein isolation alone in patients with paroxysmal atrial fibrillation.