Impact of an Empiric Isolation of the Superior Vena Cava in Addition to Circumferential Pulmonary Vein Isolation on the Outcome of Paroxysmal Atrial Fibrillation Ablation

Ejima, Koichiro; Kato, Ken; Iwanami, Yuji; Henmi, Ryuta; Daigo, Yataro; Manaka, Tetsuyuki; Fukushima, Keiko; Arai, Kotaro; Ashihara, Kaoru; Shoda, Morio; Hagiwara, Nobuhisa

doi:10.1016/j.amjcard.2015.09.005

Cited by 39 publications

(51 citation statements)

References 20 publications

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“…Because the heterogeneity was nonsignificant (chi 2 = 2.17, df = 3, I 2 = 0%, P = 0.54), we chose the fixed effects model instead of the randomeffects model to complete the merge analyses (Figure 2). Sensitivity analysis confirmed the overall differences in the recurrence rate in the empiric SVCI group compared with the conventional SVCI group of PAF, with P values of 0.007, 0.001, 0.05, and 0.0004 after exclusion of the Corrado, et al, 7) Da, et al, 11) Ejima, et al 8) and Wang, et al 10) studies, respectively. Secondary clinical outcomes: At the end of the procedure, all pulmonary veins were successfully completed in both groups.…”

Section: Resultsmentioning

confidence: 53%

“…In the end, 3 RCTs 7,10,11) and 1 nROS fulfilled all the inclusion criteria. 8) Of these, two RCTs 10,11) studied PAF by comparing PVI plus SVCI versus PVI alone. One RCT 7) studied all types of AF by comparing PVI plus SVCI versus PVI alone.…”

Section: Resultsmentioning

confidence: 99%

“…One RCT 7) studied all types of AF by comparing PVI plus SVCI versus PVI alone. The nROS 8) studied PAF by comparing PVI plus SVCI versus PVI with asneeded SVCI (SVCI was applied only if SVC-triggered AF or rapid SVC activity was observed during the procedure) ( Figure 1). The qualities of the RCTs and nROS were high.…”

Section: Resultsmentioning

confidence: 99%

“…3,5) A recent method is electrical SVCI from the RA. [7][8][9][10][11] Two randomized prospective studies 10,11) revealed no significant difference in the atrial arrhythmias occurring between the PVI group and PVI plus SVCI group in PAF patients. On the other hand, 2 other studies 7,8) found a lower recurrence rate after a single procedure in PAF patients that underwent an empiric SVCI strategy compared to the conventional SVCI group.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] Some researchers have investigated the efficacy of empiric SVC isolation (SVCI) in addition to conventional SVCI (performing SVCI only for patients who have triggers in the SVC) 6) in order to improve success rates and reduce recurrence rates in patients with AF. [7][8][9] However, some studies also have provided conflicting data indicating that there was no statistical significance for these two strategies after the initial AF ablation. 10,11) Therefore, we believed a meta-analysis of published data was needed to assess the efficacy of empiric isolation and conventional isolation of SVC in patients with paroxysmal AF (PAF).…”

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confidence: 98%

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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

Li¹,

Jiang

Zhong³

et al. 2017

Int. Heart J.

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SummaryRadiofrequency catheter ablation (RFCA) in the treatment of AF is currently based on pulmonary vein isolation (PVI). Some studies have investigated the efficacy of empiric SVC isolation (SVCI) in addition to conventional PVI in order to improve success rates and reduce recurrence rates. However, the results of the studies have given conflicting data.We performed a meta-analysis to evaluate the efficacy and safety of the empiric SVCI compared with conventional SVCI for paroxysmal atrial fibrillation (PAF) ablation.We searched MEDLINE, EMBASE, the Web of Science, and the Cochrane Database from the period January 1986 to August 2016 and identified qualified studies. The primary clinical outcome was the recurrence rate of atrial tachyarrhythmias, and the secondary clinical outcomes were procedure time, fluoroscopy time, and complications.We identified 3 randomized controlled trials (RCTs) and one nonrandomized, observational study (nROS) involving 245 patients with empiric SVCI and 269 patients with conventional SVCI. The empiric SVCI group had a lower recurrence rate of atrial tachyarrhythmia after a single procedure compared with the conventional SVCI group (16.7% versus 29.4%, OR: 0.48, 95%CI: 0.31 to 0.74, P = 0.0009). There was no significant difference in fluoroscopic time (P = 0.22), procedure time (P = 0.32), or clinical complications (P = 0.33) between the two groups.Empiric SVCI is more effective than conventional SVCI in terms of the long-term outcomes of PAF patients after a single PVI procedure, with the same fluoroscopic time, procedure time, and clinical complications. (Int Heart J 2017; 58: 500-505) Key words: Arrhythmia, Pulmonary vein, Atrial fibrillation, Meta R adiofrequency catheter ablation (RFCA) is an effective treatment option for patients with atrial fibrillation (AF). At present, RFCA in the treatment of AF is based on pulmonary vein isolation (PVI), whether it is segmental PVI or circumferential PVI.1,2) AF can be also initiated by nonpulmonary vein ectopic beats such as in the superior vena cava (SVC), coronary sinus ostium, left atrial posterior wall, crista terminalis, and ligament of Marshall.3) Despite initial positive results of the PVI strategy, RFCA that targeted the pulmonary vein alone showed a significant recurrence rate after the first procedure with the reconnection of the pulmonary vein or with the emergence of non-PV ectopic foci including the SVC.3-5) Some researchers have investigated the efficacy of empiric SVC isolation (SVCI) in addition to conventional SVCI (performing SVCI only for patients who have triggers in the SVC) 6) in order to improve success rates and reduce recurrence rates in patients with AF. 7-9) However, some studies also have provided conflicting data indicating that there was no statistical significance for these two strategies after the initial AF ablation.10,11) Therefore, we believed a meta-analysis of published data was needed to assess the efficacy of empiric isolation and conventional isolation of SVC in patients with paroxysmal AF (PAF).

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Section: Resultsmentioning

confidence: 53%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

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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

Li¹,

Jiang

Zhong³

et al. 2017

Int. Heart J.

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Initial experience of a novel method for electrical isolation of the superior vena cava using cryoballoon in patients with atrial fibrillation

Lin

Bao

Xie

et al. 2022

Clinical Cardiology

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Background Damage to the sinus node (SN) has been described as a potential complication of superior vena cava (SVC) isolation. There have been reports of permanent SN injury requiring pacemaker implantation during isolation of the SVC. Hypothesis It is safe and effective to isolate SVC with the second‐generation 28‐mm cryoballoon by using a novel method. Methods Forty‐three patients (including six redo cases) with SVC‐related atrial fibrillation (AF) from a consecutive series of 650 patients who underwent cryoballoon ablation were included. After pulmonary vein isolation was achieved, if the SVC trigger was identified, the SVC was electrically isolated using the cryoballoon. First, the cryoballoon was inflated in the right atrium (RA) and advanced towards the SVC‐RA junction. After total occlusion was confirmed by dye injection with total retention of contrast in the SVC, the SVC‐RA junction was determined. Next, the cryoballoon was deflated, advanced into SVC, then reinflated, and pulled back gently. The equatorial band of the cryoballoon was then set slightly (4.32 ± 0.71 mm) above the SVC‐RA junction for isolation of the SVC. Results Real‐time SVC potential was observed in all patients during ablation. The mean time to isolation was 24.5 ± 10.7 s. The SVC was successfully isolated in all patients. The mean number of freeze cycles was 2.5 ± 1.4 per patient, and the mean ablation time was 99.8 ± 22.7 s. A transient phrenic nerve (PN) injury occurred in one patient (2.33%). There were no SN injuries. Freedom from AF rates at 6 and 12 months was 97.7% and 93.0%, respectively. Conclusions This novel method for SVC isolation using the cryoballoon is safe and feasible when the SVC driver during AF is determined and could avoid SN injury. PN function should still be carefully monitored during an SVC isolation procedure.

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Impact of atrial fibrillation ablation on long‐term outcomes in patients with tachycardia‐bradycardia syndrome

Kataoka

Ejima

Yazaki

et al. 2022

Journal of Arrhythmia

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Background Reports of long‐term outcomes after atrial fibrillation (AF) ablation for tachycardia‐bradycardia syndrome (TBS) are limited. This study aimed to investigate the impact of radiofrequency catheter ablation (RFCA) on clinical outcomes in patients with TBS. Methods Among 1669 patients who underwent AF ablation between January 2010 and April 2020, we retrospectively enrolled 53 patients (62.3% males; age, 67.1 ± 7.0 years) who had been diagnosed with TBS before RFCA for paroxysmal AF (TBS group). After 1:2 propensity score‐matching based on age, gender, AF type, and left atrial dimension, 106 patients were assigned to the control group (non‐TBS group). The atrial tachyarrhythmia (ATA) recurrence rate and rate of avoidance of permanent pacemaker implantation (PMI) were examined. Results During a median follow‐up period of 37.7 months, the ATA recurrence rate after a single ablation procedure was significantly higher in the TBS group than in the non‐TBS group (51.0% vs. 38.5%; log‐rank p = .008); however, the ATA recurrence rate after the final ablation procedure did not significantly differ between groups. In the TBS group, the rate of PMI avoidance after AF ablation was 92.5%. A Cox‐regression multivariate analysis revealed that the presence of non‐pulmonary vein/superior vena cava premature atrial contractions (odds ratio, 3.38; 95% confidence interval, 1.49–7.66; p = .004) was an independent predictor of ATA recurrence in the TBS group. Conclusions Patients with TBS had higher ATA recurrence rates after the first ablation procedure compared to those without TBS. However, ATA recurrence after AF ablation did not necessarily result in PMI for TBS patients.

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Impact of an Empiric Isolation of the Superior Vena Cava in Addition to Circumferential Pulmonary Vein Isolation on the Outcome of Paroxysmal Atrial Fibrillation Ablation

Cited by 39 publications

References 20 publications

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

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

Initial experience of a novel method for electrical isolation of the superior vena cava using cryoballoon in patients with atrial fibrillation

Impact of atrial fibrillation ablation on long‐term outcomes in patients with tachycardia‐bradycardia syndrome

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