Key result
Empirical SVC-I added to PVI is linked to ~46% lower atrial tachyarrhythmia recurrence versus PVI alone.
Why the study?
The long-term efficacy of pulmonary vein isolation plus empiric superior vena cava isolation for the treatment of AF remains controversial.
Does empirical superior vena cava isolation added to pulmonary vein isolation reduce recurrence of atrial tachyarrhythmias in patients with atrial fibrillation?
Cohort (n=185)
Does empirical superior vena cava isolation added to pulmonary vein isolation reduce recurrence of atrial tachyarrhythmias in patients with atrial fibrillation?
Absolute Event Rate: 24.7% vs 45.7%
p-value: p=0.003
Empirical superior vena cava isolation added to pulmonary vein isolation may reduce the recurrence of atrial tachyarrhythmias in patients with persistent atrial fibrillation.
SVC-I added to PVI was associated with lower AT recurrence; leaves open whether RCTs will confirm benefit.
Background Pulmonary vein isolation (PVI) is useful for atrial fibrillation (AF). Superior vena cava (SVC) is one of the triggers of atrial fibrillation and SVC isolation (SVC-I) is applicable for some AF patients. However, long-term efficacy of PVI plus empiric SVC-I for treatment of AF is controversial. Purpose We evaluated the efficacy of empirical SVC-I added to pulmonary vein isolation (PVI). Methods We retrospectively investigated consecutive AF patients who were performed PVI from February 2020 to July 2022. Superior vena cava isolation was performed for operator’s decision regardless of SVC sleeve length. Exclusion criteria were as follows: previous cardiac surgery, previous ablation for AF, follow-up periods under one-year and unsuccessful SVC-I cases. Definition of recurrence was the confirmation of atrial tachyarrhythmias (ATs) after blanking periods. Results Consecutive 185 patients were analyzed. Sixty-five patients were recurrent ATs. Persistent AF, prior CHF, left ventricular ejection fraction (LVEF), SVC-I were significantly different in univariate analysis (44Pts vs 56Pts, p=0.008, 12Pts vs 9Pts, p=0.031, 59% vs 64%, p=0.014, 23Pts vs 70 Pts, p=0.003, respectively). Moreover, Persistent AF and SVC-I were significant differences for recurrence of ATs in Cox hazard model. In paroxysmal AF patients, there were no significant differences whether SVC-I or not. However, in persistent AF patients, additional SVC-I was lower recurrence than no SVC-I group Conclusion Pulmonary vein isolation plus empiric SVC-I may be effective for persistent AF patients.Kaplan-meier curve
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Takeuchi et al. (2026) conducted a cohort in Atrial fibrillation (n=185). Empirical superior vena cava isolation (SVC-I) added to pulmonary vein isolation (PVI) vs. Pulmonary vein isolation (PVI) alone was evaluated on Recurrence of atrial tachyarrhythmias (ATs) after blanking periods (p=0.003). Empirical superior vena cava isolation added to pulmonary vein isolation was associated with a lower recurrence of atrial tachyarrhythmias compared to PVI alone (24.7% vs 45.7%; p=0.003).
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