Key result
Empirical superior vena cava isolation in addition to pulmonary vein isolation did not improve long-term freedom from atrial tachyarrhythmia compared to pulmonary vein isolation alone in patients with persistent atrial fibrillation.
Why the study?
Studies reported conflicting results when superior vena cava isolation was combined with pulmonary vein isolation, and long-term outcomes were lacking.
Does empirical superior vena cava isolation in addition to pulmonary vein isolation reduce atrial tachyarrhythmia recurrence in patients with persistent atrial fibrillation?
Cohort (n=80)
No
Does empirical superior vena cava isolation in addition to pulmonary vein isolation reduce atrial tachyarrhythmia recurrence in patients with persistent atrial fibrillation?
Empirical superior vena cava isolation in addition to pulmonary vein isolation using a cryoballoon does not significantly improve long-term freedom from atrial tachyarrhythmia in patients with persistent atrial fibrillation.
Answers are grounded in this paper and cite their sources.
Empirical SVCi with PVi in persistent AF remains unproven; leaves open efficacy and safety in randomized trials.
BACKGROUND: Superior vena cava (SVC) is atrial fibrillation (AF)'s most common non-pulmonary vein (PV) foci. Studies reported conflictory results when SVC isolation (SVCi) was combined with PVi and long-term outcomes were lacking. Therefore, we aimed to evaluate the long-term efficacy and safety of empirical SVCi as an adjunct to cryoballoon-based PV isolation (PVi) in persistent AF ablation. METHODS: A total of 40 consecutive persistent AF patients (60.6 ± 8.2 years, 52.5% females) who underwent SVCi in addition to PVi compared with a propensity score matched cohort of 40 persistent AF patients (58.6 ± 8.7 years, 50% female) in whom PVi-only was performed. Second-generation cryoballoon (CB2) was used in all procedures. Atrial tachyarrhythmia (ATa) recurrence was defined as the detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. RESULTS: Pulmonary veins and SVC were successfully isolated in all patients. At a mean of 46.7 ± 7.8 months follow-up, 22 (55%) patients in the PVi-only group, and 27 (67.5%) patients in the PVi + SVCi group were free of ATa after the index procedure (P =.359). Phrenic nerve injury (PNI) was detected in 2 (5%) patients in the PVi-only group (during right PVi) and 2 (5%) patients in the PVi + SVCi group (during SVCi) (P = 1.00). Cox regression analysis revealed that early recurrence was the only predictor of recurrence (hazard ratio 4.88, 95% confidence interval 1.59-14.96; P =.005). CONCLUSION: Long-term results of our small sample-sized study revealed that CB-based PVi + SVCi was associated with outcomes similar to the PVi-only strategy in patients with persistent AF. Although complication rates were similar between the groups, close follow-up of diaphragmatic movement is crucial to prevent PNI during SVCi.
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Uğur Canpolat (2024) conducted a cohort in Persistent Atrial Fibrillation (n=80). Empirical superior vena cava isolation (SVCi) in addition to pulmonary vein isolation (PVi) vs. Pulmonary vein isolation (PVi) only was evaluated on Freedom from atrial tachyarrhythmia (ATa) recurrence after the index procedure (p=0.359). Empirical superior vena cava isolation in addition to pulmonary vein isolation did not improve long-term freedom from atrial tachyarrhythmia compared to pulmonary vein isolation alone in patients with persistent atrial fibrillation.
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