Atrial fibrillation resulting from superior vena cava drivers addressed with cryoballoon ablation: Late reconnection at the site of phrenic nerve pacing catheter

Ng, Brenda; Ilsar, Rahn; McGuire, Mark A.; Singarayar, Suresh

doi:10.1016/j.hrcr.2018.09.010

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…One benefit of pacing the PN via a subclavian access is to guarantee the total occlusion of the SVC with the CB. This avoids the likely formation of gaps caused by the presence of a pacing catheter positioned through a femoral access and reaching the SVC via the right atrium [ 24 ]. In our study, complete recovery of diaphragmatic contraction occurred before the end of the procedure in all patients exhibiting PNI during the ablation of the SVC.…”

Section: Discussionmentioning

confidence: 99%

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

Overeinder

Osório

Călburean

et al. 2021

J Interv Card Electrophysiol

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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.

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Section: Discussionmentioning

confidence: 99%

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

Overeinder

Osório

Călburean

et al. 2021

J Interv Card Electrophysiol

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“…Gonna et al 6 and Ng et al 7 reported a case of successful SVC isolation using second‐generation CB. Our prior animal study has reported the feasibility of SVC isolation using CB ablation 8 .…”

Section: Discussionmentioning

confidence: 99%

“…Cryoballoon (CB) ablation utilizes a catheter specifically designed for PV isolation and has been proven to be a safe and effective tool to perform PV isolation 5 . Recently, there are some case reports on SVC isolation by CB ablation 6,7 . Recently, our prior animal study has showed the feasibility of SVC isolation using the CB ablation 8 .…”

Section: Introductionmentioning

confidence: 99%

Electrical isolation of the superior vena cava using second‐generation cryoballoon in patients with atrial fibrillation

Wei

Guo

Sun

et al. 2020

Cardiovasc electrophysiol

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Background: The safety and efficacy of superior vena cava (SVC) isolation using second-generation cryoballoon (CB) ablation remain unknown.Methods: A total of 26 (3.2%) patients with SVC-related paroxysmal atrial fibrillation (AF) from a consecutive series of 806 patients who underwent secondgeneration CB were included. Pulmonary vein isolation was initially achieved by CB ablation. If the SVC trigger was determined, the electrical isolation of SVC isolation was performed using the second-generation CB. Results: Real-time SVC potential was observed in all patients. Isolation of the SVC was successfully accomplished in 21 (80.8%) patients. The mean number of freeze cycles in each patient was 2.1 ± 1.1. The mean time to isolation and ablation duration were 22.5 ± 14.2 seconds and 94.5 ± 22.3 seconds, respectively. A transient phrenic nerve (PN) injury was observed in five patients (19.2%). There were two patients (7.7%) experienced reversible sinus node injury during the first application. During a mean follow-up period of 13.2 ± 5.8 months, four patients (15.4%) had atrial arrhythmia recurrences. Conclusion: Isolation of SVC using the second-generation 28-mm CB is feasible when SVC driver during AF is identified. Vigilant monitoring of PN function during CB ablation of SVC is needed to avoid PN injury. K E Y W O R D S catheter ablation, cryoballoon, phrenic nerve, sinus node, superior vena cava

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“…One case describes the presence of an inappropriate sinus tachycardia after the procedure, though we have not observed this complication in our patients. In another case, the patient had AF recurrence after the procedure, and the authors report that the SVC was reconnected at the point where the catheter for PN pacing was located in the SVC, perhaps owing to the fact that this catheter may not allow for complete occlusion of the vein.…”

Section: Discussionmentioning

confidence: 99%

A novel simple, fast, and safe approach for effective superior vena cava isolation using the third‐generation cryoballoon

Campal

Borque

Blanco

et al. 2019

Pacing Clinical Electrophis

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Background: Superior vena cava (SVC) isolation with radiofrequency energy remains a challenge due to potential side effects, especially phrenic nerve (PN) or sinus node injury. The purpose of this study was to evaluate the feasibility of a novel SVC isolation technique using the third-generation cryoballoon (CB3). Methods:Patients undergoing atrial fibrillation (AF) ablation were prospectively included. The procedure was performed with the CB3, beginning with the pulmonary veins and ending with SVC isolation. During applications in the SVC, continuous PN capture and sinus rate were monitored.Once reached SVC isolation during the application, 60 s more was applied, with no bonus application. If after 90 s the SVC was not isolated, application was stopped. A maximum number of four applications were permitted.Results: Thirty patients (62 ± 9 years; 74% male, 78% paroxysmal AF) were included. No SVC activity was observed in two patients. Success rate for SVC isolation was 89%. Mean number of applications per patient was 2.3 ± 1. Mean time to SVC isolation was 37 ± 20 s. Mean duration of application was 92 ± 15 s. Mean total time of procedure for SVC isolation was 218 ± 43 s. We recorded only two complications: one transient PN palsy and one short and transient sinus arrest.After a mean follow-up of 5 ± 2 months, 89% are free from arrhythmia recurrence. Conclusions:We present a promising simple SVC-isolation technique using CB3, featuring a high success rate and very low incidence of complications.

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Atrial fibrillation resulting from superior vena cava drivers addressed with cryoballoon ablation: Late reconnection at the site of phrenic nerve pacing catheter

Cited by 7 publications

References 10 publications

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

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

Electrical isolation of the superior vena cava using second‐generation cryoballoon in patients with atrial fibrillation

A novel simple, fast, and safe approach for effective superior vena cava isolation using the third‐generation cryoballoon

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