Comparison of Empiric Isolation and Conventional Isolation of Superior Vena Cava in Addition to Pulmonary Vein Isolation on the Outcome of Paroxysmal Atrial Fibrillation Ablation

Li, Jinyi; Jiang, Jianlin; Zhong, Guoqiang; Ke, Honghong

doi:10.1536/ihj.16-460

Cited by 13 publications

(7 citation statements)

References 28 publications

(57 reference statements)

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“…35) RESTING HEART RATE AND ATRIAL FIBRILLATION Low RHRs are typically associated with a lower body mass index (BMI), good exercise capacity, and reduced morbidity and mortality. 36,37) Therefore, our results raise the question of why lower RHR is associated with a higher incidence of AF, which could be explained by several biological mechanisms. HR regulation is a complex interplay between vagal withdrawal and sympathetic activation during exercise.…”

Section: Discussionmentioning

confidence: 76%

Resting Heart Rate and the Risk of Atrial Fibrillation

et al. 2019

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In a previous meta-analysis, it was demonstrated that the resting heart rate (RHR) is a potential risk factor for atrial fibrillation (AF). However, the results of that meta-analysis were conflicting, and the relationship between the RHR and AF is still not well established. In the current meta-analysis, our aim is to update evidence with a better statistical model. We searched the Cochrane Library, PubMed, and Embase databases for relevant studies and used a "one-stage approach" with a restricted cubic spline model to summarize the dose-specific relationships between the RHR and AF. Relative risk (RR) was used to measure the effects. In total, 10 studies were included, with a total of 18,630 cases of AF among 431,432 participants. In the dose-response analysis, there was evidence of a nonlinear association between the RHR and the risk of AF (nonlinearity, P < 0.0001), which exhibited a significant J-shaped association between the two factors. An RHR between 68 and 80 bpm had the lowest risk of AF. Among people who had RHR < 70 bpm, the summary RR was 1.09 per 10-RHR decrease (95% confidence interval [CI] = 1.06-1.12; P < 0.001). The results were similar for participants with RHR > 70 bpm (per 10 bpm increase) (RR = 1.06, 95% CI = 1.03-1.08; P < 0.001). Our dose-response metaanalysis revealed a significant J-shaped association between the RHR and AF. Both low RHR and high RHR were associated with an increased risk of AF compared with a modest RHR of 68-80 bpm.

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Section: Discussionmentioning

confidence: 76%

Resting Heart Rate and the Risk of Atrial Fibrillation

et al. 2019

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“…RF ablation of the SVC has already been shown to be a safe and feasible approach for the treatment of AF, but it may be hampered by the potential thermal injury of collateral tissue (e.g., the proximal phrenic nerve) 33 . In the present study, ablations of the SVC using PFA were completely circumferential and transmural without any gaps along the circumference of the lesion.…”

Section: Discussionmentioning

confidence: 50%

Safety and chronic lesion characterization of pulsed field ablation in a Porcine model

Stewart

Haines

Miklavčič

et al. 2021

Cardiovasc electrophysiol

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Background Pulsed field ablation (PFA) has been identified as an alternative to thermal‐based ablation systems for treatment of atrial fibrillation patients. The objective of this Good Laboratory Practice (GLP) study was to characterize the chronic effects and safety of overlapping lesions created by a PFA system at intracardiac locations in a porcine model. Methods A circular catheter with nine gold electrodes was used for overlapping low‐ or high‐dose PFA deliveries in the superior vena cava (SVC), right atrial appendage (RAA), and right superior pulmonary vein (RSPV) in six pigs. Electrical isolation was evaluated acutely and chronic lesions were assessed via necropsy and histopathology after 4‐week survival. Acute and chronic safety data were recorded peri‐ and post‐procedurally. Results No animal experienced ventricular arrhythmia during PFA delivery, and there was no evidence of periprocedural PFA‐related adverse events. Lesions created in all anatomies resulted in electrical isolation postprocedure. Lesions were circumferential, contiguous, and transmural, with all converting into consistent lines of chronic replacement fibrosis, regardless of trabeculated or smooth endocardial surface structure. Ablations were non‐thermally generated with only minimal post‐delivery temperature rises recorded at the electrodes. There was no evidence of extracardiac damage, stenosis, aneurysms, endocardial disruption, or thrombus. Conclusion PFA deliveries to the SVC, RAA, and RSPV resulted in complete circumferential replacement fibrosis at 4‐week postablation with an excellent chronic myocardial and collateral tissue safety profile. This GLP study evaluated the safety and efficacy of a dosage range in preparation for a clinical trial and characterized the non‐thermal nature of PFA.

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“…Nevertheless, this finding was mainly driven by the non-randomized study. The heterogeneous ablation strategies among the included studies and the small sample size are important limitations [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

Efficacy, Safety and Feasibility of Superior Vena Cava Isolation in Patients Undergoing Atrial Fibrillation Catheter Ablation: An Up-to-Date Review

et al. 2023

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Pulmonary vein isolation (PVI) is the cornerstone in atrial fibrillation (AF) ablation; yet, the role of arrhythmogenic superior vena cava (SVC) is increasingly recognized and different ablation strategies have been employed in this context. SVC can act as a trigger or perpetuator of AF, and its significance might be more pronounced in patients undergoing repeated ablation. Several cohorts have examined efficacy, safety and feasibility of SVC isolation (SVCI) among AF patients. The majority of these studies explored as-needed SVCI during index PVI, and only a minority of them included repeated ablation subjects and non-radiofrequency energy sources. Studies of heterogeneous design and intent have explored both empiric and as-needed SVCI on top of PVI and reported inconclusive results. These studies have largely failed to demonstrate any clinical benefit in terms of arrhythmia recurrence, although safety and feasibility are undisputable. Mixed population demographics, small number of enrollees and short follow-up are the main limitations. Procedural and safety data are comparable between empiric SVCI and as-needed SVCI, and some studies suggested that empiric SVCI might be associated with reduced AF recurrences in paroxysmal AF patients. Currently, no study has compared different ablation energy sources in the setting of SVCI, and no randomized study has addressed as-needed SVCI on top of PVI. Furthermore, data regarding cryoablation are still in their infancy, and regarding SVCI in patients with cardiac devices more safety and feasibility data are needed. PVI non-responders, patients undergoing repeated ablation and patients with long SVC sleeves could be potential candidates for SVCI, especially via an empiric approach. Although many technical aspects remain unsettled, the major question to answer is which clinical phenotype of AF patients might benefit from SVCI?

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Comparison of Empiric Isolation and Conventional Isolation of Superior Vena Cava in Addition to Pulmonary Vein Isolation on the Outcome of Paroxysmal Atrial Fibrillation Ablation

Cited by 13 publications

References 28 publications

Resting Heart Rate and the Risk of Atrial Fibrillation

Resting Heart Rate and the Risk of Atrial Fibrillation

Safety and chronic lesion characterization of pulsed field ablation in a Porcine model

Efficacy, Safety and Feasibility of Superior Vena Cava Isolation in Patients Undergoing Atrial Fibrillation Catheter Ablation: An Up-to-Date Review

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