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Multicenter Study
. 2023 Mar;66(2):435-443.
doi: 10.1007/s10840-022-01314-w. Epub 2022 Aug 18.

Role of empirical isolation of the superior vena cava in patients with recurrence of atrial fibrillation after pulmonary vein isolation-a multi-center analysis

Sven Knecht #  1   2 , Ivan Zeljkovic #  3 , Patrick Badertscher  4   5 , Philipp Krisai  4   5 , Florian Spies  4   5 , Jan Vognstrup  4 , Nikola Pavlovic  6 , Sime Manola  6 , Stefan Osswald  4   5 , Michael Kühne #  4   5 , Christian Sticherling #  4   5
Affiliations
Multicenter Study

Role of empirical isolation of the superior vena cava in patients with recurrence of atrial fibrillation after pulmonary vein isolation-a multi-center analysis

Sven Knecht et al. J Interv Card Electrophysiol. 2023 Mar.

Abstract

Background: Non-pulmonary vein (PV) triggers play a role in the initiation of atrial fibrillation (AF), with the superior vena cava (SVC) being a common location. The aim of the current study was to investigate a strategy of empirical SVC isolation (SVCI) in addition to re-isolation of PV in patients with recurrence of AF after index PV isolation (PVI).

Methods: We retrospectively analyzed consecutive patients from two centers with recurrence of AF after index PVI, undergoing a repeat ablation. Whereas only a re-isolation of the PV was intended in patients with reconnections of equal or more than two PV (PVI group), an additional SVCI was aimed for in patients with < 2 isolated PV in addition to the re-isolation of the PV (PVI + group). Analysis was performed as-treated and per-protocol.

Results: Of the 344 patients included in the study (age 60 ± 10 years, 73% male, 66% paroxysmal AF), PVI only was performed in 269 patients (77%) and PVI plus SVCI (PVI +) in 75 patients (23%). Overall, freedom from AF/AT after repeat PVI was 80% (196 patients) in the PVI group and 73% in the PVI + group (p = 0.151). In multivariable Cox regression analysis, presence of persistent AF (HR 2.067 (95% CI 1.389-3.078), p < 0.001) and hypertension (HR 1.905 (95% CI 1.218-2.980), p = 0.005) were identified as only significant predictors of AF/AT recurrence. The per-protocol results did not differ from this observation.

Conclusions: A strategy of an empirical additional SVCI at repeat PVI ablation for recurrence of AF/AT does not improve outcome compared to a PVI only approach.

Keywords: Atrial fibrillation; Isolation; Pulmonary vein isolation; Recurrence; Repeat; Superior vena cava.

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Conflict of interest statement

• C.S. reports grants from the European Union’s FP7 program, Biosense-Webster, and lecture and consulting fees from Abbott, Medtronic, Biosense-Webster, Boston Scientific, Microport, and Biotronik all outside the submitted work.

• M.K. reports grants from the Swiss National Science Foundation, Swiss Heart Foundation, Bayer, and personal fees from Bayer, Böhringer Ingelheim, Pfizer BMS, Daiichi Sankyo, Medtronic, Biotronik, Boston Scientific, and Johnson & Johnson all outside the submitted work.

• S.K. reports grant from the Stiftung Kardiovaskuläre Forschung, outside the submitted work.

• N.P. reports speaker’s honoraria from Medtronic and Biosense Webster, and proctoring fees from Biosense Webster, all outside the submitted work.

• Others – none

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curves stratified by (A) the ablation group, (B) the prevalence of paroxysmal AF, and (C) the prevalence of hypertension
See this image and copyright information in PMC

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References

    1. Santangeli P, Zado ES, Hutchinson MD, Riley MP, Lin D, Frankel DS, Supple GE, Garcia FC, Dixit S, Callans DJ, Marchlinski FE. Prevalence and distribution of focal triggers in persistent and long-standing persistent atrial fibrillation. Heart Rhythm. 2016;13:374–382. doi: 10.1016/j.hrthm.2015.10.023. - DOI - PubMed
    1. Di Biase L, Burkhardt JD, Mohanty P, Sanchez J, Mohanty S, Horton R, Gallinghouse GJ, Bailey SM, Zagrodzky JD, Santangeli P, Hao S, Hongo R, Beheiry S, Themistoclakis S, Bonso A, Rossillo A, Corrado A, Raviele A, Al-Ahmad A, Wang P, Cummings JE, Schweikert RA, Pelargonio G, Dello Russo A, Casella M, Santarelli P, Lewis WR, Natale A. Left atrial appendage: an underrecognized trigger site of atrial fibrillation. Circulation. 2010;122:109–118. doi: 10.1161/CIRCULATIONAHA.109.928903. - DOI - PubMed
    1. Hwang C, Karagueuzian HS, Chen P-S. Idiopathic Paroxysmal atrial fibrillation induced by a focal discharge mechanism in the left superior pulmonary vein. J Cardiovasc Electrophysiol. 1999;10:636–648. doi: 10.1111/j.1540-8167.1999.tb00240.x. - DOI - PubMed
    1. Kawai S, Mukai Y, Inoue S, Yakabe D, Nagaoka K, Sakamoto K, Takase S, Chishaki A, Tsutsui H. Non-pulmonary vein triggers of atrial fibrillation are likely to arise from low-voltage areas in the left atrium. Sci Rep. 2019;9:12271. doi: 10.1038/s41598-019-48669-1. - DOI - PMC - PubMed
    1. Hashizume H, Ushiki T, Abe K. A histological study of the cardiac muscle of the human superior and inferior venae cavae. Arch Histol Cytol. 1995;58:457–464. doi: 10.1679/aohc.58.457. - DOI - PubMed

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