Persistent left superior vena cava isolation in patients with atrial fibrillation: Selective or empirical?

Jianquan Chen; Yue Qiu; Hongwu Chen; Caiyi Jin; Yuxuan Wang; Weizhu Ju; Gang Yang; Kai Gu; Hailei Liu; Zidun Wang; Xiaohong Jiang; Mingfang Li; Daowu Wang

doi:10.1111/pace.14872

November 1, 2023Pacing and Clinical Electrophysiology

Persistent left superior vena cava isolation in patients with atrial fibrillation: Selective or empirical?

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Why the study?

Persistent left superior vena cava (PLSVC) is a prevalent thoracic venous abnormality and an arrhythmogenic source in AF, but the role of selective versus empirical isolation is unclear.

Does persistent left superior vena cava isolation prevent atrial fibrillation recurrence in patients with concomitant PLSVC?

Structured PICO

Does persistent left superior vena cava isolation prevent atrial fibrillation recurrence in patients with concomitant PLSVC?

P

Population

17 patients with atrial fibrillation (AF) and persistent left superior vena cava (PLSVC) undergoing radiofrequency ablation (identified from a larger cohort of 3950 patients), mean age 59.4 ± 8.0 years, 64.7% male.

I

Intervention

Persistent left superior vena cava (PLSVC) isolation (performed either empirically during the index procedure or selectively after AF recurrence).

O

Outcome

Freedom from atrial fibrillation (AF) or atrial tachycardia (AT)hard clinical

Empirical isolation of a persistent left superior vena cava in addition to pulmonary vein isolation appears to be a feasible and safe strategy to prevent atrial fibrillation recurrence in affected patients.

Implication

May support PLSVC isolation in select AF cases; leaves open need for prospective trials on efficacy and selection.

Abstract

BACKGROUND: Persistent left superior vena cava (PLSVC) is the most prevalent form of thoracic venous abnormality and can serve as a significant arrhythmogenic source in atrial fibrillation (AF). METHODS AND RESULTS: Among the 3950 patients who underwent radiofrequency ablation for AF between September 2014 to April 2020, 17 patients (mean age 59.4 ± 8.0 years, 64.7% male) with PLSVC were identified. Among them, nine patients (52.9%) had a prior history of pulmonary vein isolation (PVI) alone. Eight out of nine patients who experienced AF recurrence underwent PLSVC isolation with or without pulmonary vein (PV) reconnection. For the remaining eight patients (47.1%), PVI plus PLSVC isolation were performed during the index procedure. Ectopy originating from PLSVC was documented in 11 patients (64.7%) and successful PLSVC isolation was achieved in 16 patients (94.1%). After a median follow-up of 28.3 months, freedom from AF/ atrial tachycardia (AT) was observed in 13 patients (76.5%). CONCLUSION: Empirical PLSVC isolation beyond PVI appears to be a feasible and safe strategy to prevent AF recurrence in patients with concomitant PLSVC.