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

• DOI: 10.1007/s10840-020-00932-6
• Publication Date: 2021-01-15T02:11:50Z
• Authors: Ingrid Overeinder; Thiago Guimarães ...; Paul-Adrian Călbu...; Antonio Bisignani; Gezim Bala; Juan Sieira; Erwin Ströker; Maysam Al Houssari; Joerelle Mojica; Serge Boveda; Gaetano Paparella; Pedro Brugada; Carlo de Asmundis; Gian-Battista Chi...
• Keywords: Superior vena cava isolation; 2. Zero hunger; Vena Cava, Superior; Second-generation cryoballoon; Pulmonary vein isolation; Cryosurgery; Article; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Pulmonary Veins; Atrial Fibrillation; Catheter Ablation; Humans; paroxysmal atrial fibrillation; Retrospective Studies

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.