Key result
Adding SVCI to CPVI fails to improve 12-month arrhythmia freedom in paroxysmal AF.
Why the study?
Data regarding whether empirical superior vena cava isolation improves the success rate of paroxysmal atrial fibrillation ablation are conflicting.
Does empirical electroanatomical mapping-guided superior vena cava isolation in addition to circumferential pulmonary vein isolation reduce the recurrence of atrial tachyarrhythmias in patients with paroxysmal atrial fibrillation without provoked superior vena cava triggers?
RCT (n=130)
1:1
Yes
Does empirical electroanatomical mapping-guided superior vena cava isolation in addition to circumferential pulmonary vein isolation reduce the recurrence of atrial tachyarrhythmias in patients with paroxysmal atrial fibrillation without provoked superior vena cava triggers?
Empirical superior vena cava isolation added to circumferential pulmonary vein isolation does not significantly improve the 12-month freedom from atrial tachyarrhythmias in paroxysmal atrial fibrillation patients without provoked superior vena cava triggers.
Answers are grounded in this paper and cite their sources.
Empirical SVCI adds no benefit to CPVI in PAF without provoked SVC triggers; challenges routine use and supports trigger-guided isolation only.
AIMS: Data about whether empirical superior vena cava (SVC) isolation (SVCI) improves the success rate of paroxysmal atrial fibrillation (PAF) are conflicting. This study sought to first investigate the characteristics of SVC-triggered atrial fibrillation and secondly investigate the impact of electroanatomical mapping-guided SVCI, in addition to circumferential pulmonary vein isolation (CPVI), on the outcome of PAF ablation in the absence of provoked SVC triggers. METHODS AND RESULTS: A total of 130 patients undergoing PAF ablation underwent electrophysiological studies before ablation. In patients for whom SVC triggers were identified, SVCI was performed in addition to CPVI. Patients without provoked SVC triggers were randomized in a 1:1 ratio to CPVI plus SVCI or CPVI only. The primary endpoint was freedom from any documented atrial tachyarrhythmias lasting over 30 s after a 3-month blanking period without anti-arrhythmic drugs at 12 months after ablation. Superior vena cava triggers were identified in 30 (23.1%) patients with PAF. At 12 months, 93.3% of those with provoked SVC triggers who underwent CPVI plus SVCI were free from atrial tachyarrhythmias. In patients without provoked SVC triggers, SVCI, in addition to CPVI, did not increase freedom from atrial tachyarrhythmias (87.9 vs. 79.6%, log-rank P = 0.28). CONCLUSION: Electroanatomical mapping-guided SVCI, in addition to CPVI, did not increase the success rate of PAF ablation in patients who had no identifiable SVC triggers. REGISTRATION: ChineseClinicalTrials.gov: ChiCTR2000034532.
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Dong et al. (2024) conducted an RCT in Paroxysmal atrial fibrillation (PAF) (n=130). Electroanatomical mapping-guided superior vena cava isolation (SVCI) plus circumferential pulmonary vein isolation (CPVI) vs. Circumferential pulmonary vein isolation (CPVI) only was evaluated on Freedom from any documented atrial tachyarrhythmias lasting over 30 s after a 3-month blanking period without anti-arrhythmic drugs at 12 months (p=0.28). Electroanatomical mapping-guided SVCI plus CPVI did not significantly increase 12-month freedom from atrial tachyarrhythmias vs CPVI alone in PAF without provoked SVC triggers (87.9% vs 79.6%, p=0.28).
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