Comparison between superior vena cava ablation in addition to pulmonary vein isolation and standard pulmonary vein isolation in patients with paroxysmal atrial fibrillation with the cryoballoon technique

Ingrid Overeinder, Thiago Guimarães Osório, Paul-Adrian Călburean, Antonio Bisignani, Gezim Bala, Juan Sieira, Erwin Ströker, Maysam Al Houssari, Joerelle Mojica, Serge Boveda, Gaetano Paparella, Pedro Brugada, Carlo de Asmundis, Gian-Battista Chierchia, Ingrid Overeinder, Thiago Guimarães Osório, Paul-Adrian Călburean, Antonio Bisignani, Gezim Bala, Juan Sieira, Erwin Ströker, Maysam Al Houssari, Joerelle Mojica, Serge Boveda, Gaetano Paparella, Pedro Brugada, Carlo de Asmundis, Gian-Battista Chierchia

Abstract

Background: Paroxysmal atrial fibrillation (PAF) can be triggered by non-pulmonary vein foci, like the superior vena cava (SVC). The latter is correlated with improved result in terms of freedom from atrial tachycardias (ATs), when electrical isolation of this vessel utilizing radiofrequency energy (RF) is achieved.

Objectives: Evaluate the clinical impact, in patients with PAF, of the SVC isolation (SVCi) in addition to ordinary pulmonary vein isolation (PVI) by means of the second-generation cryoballoon (CB) METHODS: A total of 100 consecutive patients that underwent CB ablation for PAF were retrospectively selected. Fifty consecutive patients received PVI followed by SVCi by CB application, and the following 50 consecutive patients received standard PVI. All patients were followed 12 months.

Results: The mean time to SVCi was 36.7 ± 29.0 s and temperature at SVC isolation was - 35 (- 18 to - 40) °C. Real-time recording (RTR) during SVCi was observed in 42 (84.0%) patients. At the end of 12 months of follow-up, freedom from ATs was achieved in 36 (72%) patients in the PVI only group and in 45 (90%) patients of the SVC and PV isolation group (Fisher's exact test p = 0.039, binary logistic regression: p = 0.027, OR = 0.28, 95%CI = 0.09-0.86). In survival analysis, SVC and PV isolation group was also associated with improved freedom from ATs (log-rank test: p = 0.017, Cox regression: p = 0.026, HR = 0.31, 95%CI = 0.11-0.87).

Conclusion: Superior vena cava isolation with the CB in addition to PVI might improve freedom from ATs if compared to PVI alone at 1-year follow-up.

Keywords: Paroxysmal atrial fibrillation; Pulmonary vein isolation; Second-generation cryoballoon; Superior vena cava isolation.

Conflict of interest statement

S.B. is consultant for Medtronic, Boston Scientific, and Microport. C.d.A. reports speaker fees for Medtronic, Biotronik, Biosense Webster, Abbott, and Boston Scientific; teaching honoraria from Medtronic, Biotronik, Abbott, and Boston Scientific; proctoring honoraria from Medtronic, Abbott and Biotronik. G.B.C. reports speaker fees for Medtronic, Biotronik, Biosense Webster, and Abbott; teaching honoraria from Medtronic and Biotronik; proctoring honoraria from Medtronic. P.B. reports consulting fees and speaker honoraria from Medtronic.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Real-time SVC electrical activity. Example of potentials recorded at the ostium of the SVC during sinus rhythm prior to isolation and electrical isolation of the SVC as measured by the circular mapping catheter (yellow arrow). Shown are surface leads V1, I, II, and AVF and bipolar intracardiac electrograms recorded by circular mapping catheter (MAP 1- 4)
Fig. 2
Fig. 2
SVC isolation as seen from LAO incidence (A) and from PA incidence (B).
Fig. 3
Fig. 3
Freedom from ATs recurrence among the study arms.

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