Novel Ablation Strategy for Isolating the Superior Vena Cava Using Ultra High-Resolution Mapping

Sinus node dysfunction characterized by reduction only in maximum heart rate during exercise after superior vena cava isolation in atrial fibrillation catheter ablation—A potential complication

“…7,8 Ablation at the septal side of the SVC can also injure the SNA. 9,10 In our patient, CT angiography showed a typical configuration of SNA anatomy arising from the right coronary artery, and it was less likely that the artery had been injured during SVC isolation compared to the artery arising from the left circumflex artery. Obtaining preoperative coronary CT images may be useful for determining the course of the SNA to avoid injury.…”

“…Tanaka and colleagues 10 reported that approximately half of patients with AF had a diagonal line of block at the RA-SVC junction that could be utilized to isolate the SVC with less RF delivery. Recognizing sinus node location and the RA-SVC gap also helps reduce unnecessary ablation injury to the sinus node.…”

Comparison of ablation outcomes of the second ablation procedure for recurrent atrial fibrillation using an ultra‐high‐resolution mapping system and conventional mappings system

“…A previous study reported that the tiny electrode of the mini‐basket catheter, which clearly records the gap signal, and the excellent electrogram annotation enables visualization of the PV gap using UHR‐EAM . In addition, the efficacy of UHR‐EAM using the basket catheter for SVC isolation has also been reported …”

“…3 In addition, the efficacy of UHR-EAM using the basket catheter for SVC isolation has also been reported. 8,9 The superior ablation outcome using UHR-EAM was observed for the ablation of AT, including not only typical macro-reentrant AT (perimitral and roof-dependent) but also atypical macro-reentrant and focal AT. UHR-EAM enabled the efficient visualization of AT circuits, including the exact location of the slow-conduction isthmus for macro-reentrant AT and the earliest activation site for focal AT.…”

Isoproterenol-dependent acute reconnection following superior vena cava isolation: Pitfalls of a novel approach using spontaneous conduction block

“…PN injury is still observed but can be easily prevented with high-output pacing to exclude a course of the PN. Furthermore, Tanaka and colleagues 3 reported a novel strategy of SVC isolation using ultra-high-resolution mapping with SVC foci triggering AF. Patients with the spontaneous conduction block line received point-by-point radiofrequency (RF) applications that were delivered to connect the 2 open ends of the conduction block line, and RF applications were unnecessary along the block line to complete SVC isolation, leading to a reduced number of RF deliveries.…”