In patients with non-paroxysmal atrial fibrillation and low voltage areas, adding superior vena cava isolation to pulmonary vein isolation achieved a 73.0% atrial tachyarrhythmia-free survival after multiple sessions, compared to 48.5% with PVI alone.
Cohort (n=153)
No
Does empiric superior vena cava isolation in addition to pulmonary vein isolation improve atrial tachyarrhythmia/AF-free survival in patients with non-paroxysmal atrial fibrillation?
Empiric superior vena cava isolation in addition to pulmonary vein isolation may compensate for impaired outcomes in non-paroxysmal atrial fibrillation patients who have left atrial low-voltage areas.
Absolute Event Rate: 73% vs 48.5%
Abstract Background This study aimed to investigate the correlation between left atrial low‐voltage areas (LVAs) and an arrhythmogenic superior vena cava (SVC) and the impact on the efficacy of an empiric SVC isolation (SVCI) along with a pulmonary vein isolation (PVI) of non‐paroxysmal atrial fibrillation (non‐PAF) with or without LVAs. Methods We retrospectively enrolled 153 consecutive patients with non‐PAF who underwent a PVI alone (n = 51) or empiric PVI plus an SVCI (n = 102). Left atrial voltage maps were constructed during sinus rhythm to identify the LVAs (<0.5 mV). An arrhythmogenic SVC was defined as firing from the SVC and an SVC associated with the maintenance of AF‐like rapid SVC activity. Results An arrhythmogenic SVC and LVAs were identified in 28% and 65% of patients with a PVI alone and 36% and 73% of patients with a PVI plus SVCI, respectively ( P = .275 and P = .353). In the multivariate analysis a female gender, higher pulmonary artery systolic pressure (PAPs), and arrhythmogenic SVC were associated with the presence of LVAs. In the PVI plus SVCI strategy, there was no significant difference in the atrial tachyarrhythmia/AF‐free survival between the patients with and without LVAs after initial and multiple sessions (50% vs. 61%; P = .386, 73% vs. 79%; P = .530), however, differences were observed in the PVI alone group (27% vs. 61%; P = .018, 49% vs. 78%; P = .046). Conclusions The presence of LVAs was associated with an arrhythmogenic SVC. An SVCI may have the potential to compensate for an impaired outcome after a PVI in non‐PAF patients with LVAs.
Omuro et al. (Tue,) conducted a cohort in Non-paroxysmal atrial fibrillation (n=153). Pulmonary vein isolation (PVI) plus superior vena cava isolation (SVCI) vs. PVI alone was evaluated on Atrial tachyarrhythmia/AF-free survival after multiple sessions in patients with low voltage areas. In patients with non-paroxysmal atrial fibrillation and low voltage areas, adding superior vena cava isolation to pulmonary vein isolation achieved a 73.0% atrial tachyarrhythmia-free survival after multiple sessions, compared to 48.5% with PVI alone.