The importance of superior vena cava isolation in ablation strategy for atrial fibrillation

PURPOSE OF REVIEW: Superior vena cava (SVC) is one of the most important nonpulmonary vein origins of atrial fibrillation, and SVC should be carefully treated in order to decrease the recurrence of atrial fibrillation after ablation. Despite the fact that pulmonary vein isolation (PVI) should be performed prophylactically for all pulmonary veins, prophylactic SVC isolation (SVCI) is still controversial. This review describes recent data on treatments for SVC focus during atrial fibrillation ablation. RECENT FINDINGS: There are two different major approaches to treat SVC focus during atrial fibrillation ablation. One is the conventional approach, in which SVCI is performed only if atrial fibrillation from SVC origin is recognized using pacing maneuvers and/or isoproterenol infusions. Another approach is performing SVCI in all cases prophylactically in addition to PVI. The rate of atrial fibrillation freedom 1 year after initial atrial fibrillation ablation by prophylactic PVI along with SVCI was almost the same as with the conventional method (85-90% atrial fibrillation freedom). In addition, the conventional method also had a good result even 5 years after ablation (73.3%). SUMMARY: Because of the good result after using the conventional approach and possible complications during SVCI, SVCI should be performed only if SVC focus is recognized, not prophylactically.