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. 2024 Jul 2;26(7):euae160.
doi: 10.1093/europace/euae160.

Superior vena cava isolation using a pentaspline pulsed-field ablation catheter: feasibility and safety in patients undergoing atrial fibrillation catheter ablation

Pierre Ollitrault  1 , Corentin Chaumont  2 , Jonaz Font  1   3 , Martin Manninger  4 , Sergio Conti  5 , Paweł T Matusik  6   7 , Bart A Mulder  8 , Virginie Ferchaud  1 , Arnaud Pellissier  1 , Mayane Al Khoury  1 , Paul Milliez  1   3 , Laure Champ-Rigot  1 , Frédéric Anselme  2
Affiliations

Superior vena cava isolation using a pentaspline pulsed-field ablation catheter: feasibility and safety in patients undergoing atrial fibrillation catheter ablation

Pierre Ollitrault et al. Europace. .

Abstract

Aims: Superior vena cava (SVC) isolation during atrial fibrillation catheter ablation is limited by the risk of collateral damage to the sinus node and/or the phrenic nerve. Due to its tissue-specificity, we hypothesized the feasibility and safety of pulsed-field ablation (PFA)-based SVC isolation.

Methods and results: One hundred and five consecutive patients undergoing PFA-based AF catheter ablation were prospectively included. After pulmonary vein isolation (±posterior wall isolation and electrical cardioversion), SVC isolation was performed using a standardized workflow. Acute SVC isolation was achieved in 105/105 (100%) patients after 6 ± 1 applications. Transient phrenic nerve stunning occurred in 67/105 (64%) patients but without phrenic nerve palsy at the end of the procedure and at hospital discharge. Transient high-degree sinus node dysfunction occurred in 5/105 (4.7%) patients, with no recurrence at the end of the procedure and until discharge. At the 3-month follow-up visit, no complication occurred.

Conclusion: SVC isolation using a pentaspline PFA catheter is feasible and safe.

Keywords: Atrial fibrillation; Catheter ablation; Feasibility; Outcome; Pulsed-field ablation; Superior vena cava.

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Conflict of interest statement

Conflict of interest: P.O. received consulting fees from Abbott, Biotronik, Boston Scientific, and Medtronic. M.M. received speaker fees/honoraria from Abbott, Bayer Healthcare, Biosense Webster, Biotronik, Amomed, AOP Orphan, Boston Scientific, Daiichi Sankyo, and BMS/Pfizer and research grants from Biosense Webster and Abbott. S.C. received consulting fees/honoraria from Abbott and Boston Scientific. P.M. received consulting fees from Biotronik and Boston Scientific. L.C.-R. received consulting fees from Boston Scientific, Medtronic, and Microport CRM. F.A. received consulting fees and speaker honoraria from Microport CRM, Boston Scientific, and Medtronic.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Superior vena cava isolation workflow. (A) Over-the-wire undeployed pentaspline PFA catheter (Farawave™, Boston Scientific, USA) in the SVC. (B) Deployment of the pentaspline PFA catheter in the SVC and slow withdrawal towards RA. (C) From top to bottom: surface ECG, CS catheter, and Farawave™ catheter. Distinct RA far-field (blue arrow) and SVC potential (orange arrow) can be seen, as well as a PAC originating from the SVC (yellow arrow). (D) From top to bottom: same as (C). First PFA application and subsequent SVC isolation. PAC, premature atrial contraction; PFA, pulsed-field ablation; RA, right atrial; SVC, superior vena cava.
Figure 2
Figure 2
Illustrative example of pre- and post-SVC isolation using the pentaspline PFA catheter, with an electroanatomical mapping system. Right atrial voltage mapping in sinus rhythm (0.05–0.5 mV). Left panel, pre-SVC isolation; right panel, post-SVC isolation. White dashed lines represent SVC anatomy. DCC, direct current cardioversion; PFA, pulsed field ablation; PVI, pulmonary vein isolation; PWI, posterior wall isolation; SVC, superior vena cava.
Figure 3
Figure 3
Safety outcome regarding sinus node function. Sinus node function (RR interval in ms; median; quartiles 1 and 3; and minimum and maximum values) before and after SVC isolation workflow. DCC, direct current cardioversion; PFA, pulsed-field ablation; PVI, pulmonary vein isolation; PWI, posterior wall isolation; SVC, superior vena cava.
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References

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