Circumferential versus focal superior vena cava ablation using the lattice tip catheter: insights from a multicenter experience

Background Superior vena cava (SVC) is a known source of arrhythmic triggers in atrial fibrillation. Prior studies with the pentaspline pulsed field ablation (PFA) catheter reported high acute procedural success. Purpose to evaluate the acute and chronic efficacy of SVC isolation using the lattice-tip PFA catheter. Methods Consecutive patients undergoing PFA for AF between November 2024 and October 2025 were prospectively enrolled in this multicenter study. SVC isolation was performed at the SVC right atrial junction. Patients were divided into two groups: (1) focal ablation only in the area of earliest activation leading to immediate exit block (2) and circumferential SVC ablation. Acute procedural success was defined as exit block confirmed by the absence of near-field electrograms in the SVC. Persistent isolation was assessed during remapping in a repeat procedure. Result A total of 713 [420, 58.9% male; mean age 66 ± 8.73 years] patients undergoing SVC isolation were included in this analysis. PFA was the only energy used for SVC isolation. Group 1 included 315(45%) patients who received an average of 3 ± 1 applications, while 375 patients (55%) in group 2 received a mean of 9 ± 3 applications. Acute SVC isolation was achieved in all (100%) in both groups. 161(23%) patients underwent repeat mapping at 186±68 days. SVC reconnection occurred in 83 of 85 patients in group 1, compared with only 3 of 76 patients in group 2 (p<0.001). Conclusion When using lattice-tip PFA catheter, SVC isolation should be performed with a compleat circumferential approach.