What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (AF) (n=76). Intervention: Superior vena cava (SVC) isolation vs. Pulmonary vein (PV) isolation. Primary outcome: Prevalence of reconnection at repeat ablation (p=0.129).

What does this research mean for the field?

Superior vena cava (SVC) reconnection is common, occurring in 74% of patients undergoing repeat ablation for atrial fibrillation, which is a prevalence similar to that of pulmonary vein reconnection. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 22, 2012Open Access

Conduction Recovery After Electrical Isolation of Superior Vena Cava

SMShinsuke MiyazakiElectrophysiology HTHiroshi TaniguchiFujita Health University SKShigeki KusaTsuchiura Kyodo General Hospital

Key Result

Superior vena cava reconnection was observed in 74% of patients undergoing repeat ablation, a prevalence similar to pulmonary vein reconnection (73% vs 84%, P=0.129).

Study Design

Type

Cohort (n=76)

Structured PICO

What is the prevalence and electrophysiological characteristics of superior vena cava reconnection in patients undergoing repeat ablation for recurrent atrial fibrillation?

Population

76 consecutive patients (mean age 64.6 ± 8.5 years, 77.6% male) with drug-refractory symptomatic atrial fibrillation who underwent repeat catheter ablation for recurrent atrial tachyarrhythmia at a single center in Japan, all of whom had electrical superior vena cava (SVC) isolation following pulmonary vein antrum isolation (PVAI) at the initial procedure.

Intervention

Evaluation of superior vena cava (SVC) reconnection and electrophysiological properties during repeat catheter ablation.

Comparator

Pulmonary vein (PV) reconnection (evaluated in a subset of 63 patients who underwent both PV and SVC isolation at the initial procedure).

Outcome

Prevalence of SVC reconnection and location of conduction gaps at the time of repeat ablation.surrogate

Superior vena cava electrical reconnection is common after previous isolation, occurring at a similar rate to pulmonary vein reconnection, with conduction gaps typically found at the anterolateral SVC-right atrium junction.

Main Result

Absolute Event Rate: 73% vs 84%

p-value: p=0.129

Abstract

BACKGROUND: Superior vena cava (SVC) is an infrequent yet an important source of atrial fibrillation (AF). The data on SVC reconnection are limited. METHODS AND RESULTS: Following pulmonary vein (PV) antrum isolation for AF, SVC isolation was systemically performed under angiographic and mapping guidance using 4-mm non-irrigated tip catheter. SVC reconnection could be evaluated in 76 consecutive patients (65 ± 9 years, 59 male) who underwent repeat AF ablation after 16 ± 16 months. SVC was isolated at the 1(st), 2(nd), 3(rd) and 4(th) AF ablation procedure in 63, 7, 5 and 1 patient by 7.3 ± 3.1 radiofrequency applications. SVC reconnection was observed in 56 patients (74%). In the majority, the conduction gap was located at the anterolateral SVC-right atrium (RA) junction. After re-isolation of SVC, 2/7 patients (29%) had reconnection at the following procedure. Among 63 patients who underwent PV and SVC isolation at the initial procedure, the prevalence of reconnection for PV and that for SVC were similar (53/63, 84% vs. 46/63, 73%; P=0.129). Dissociated activity, however, was more frequently observed in the PVs than in the SVC (47/63, 73% vs. 10/63, 16%; P<0.0001). During the procedure, AF initiation from a thoracic vein was identified in 19/63 patients (30%). CONCLUSIONS: SVC reconnection is common after 1 or more previous isolation procedures undertaken for AF ablation. Its prevalence is similar to that of PV reconnection. The location of the conduction gap varies widely but is most frequently found at the anterolateral SVC-RA junction.

Ask AI

Helpful

Bookmark

View Full Paper