Sinus Node Injury as a Result of Superior Vena Cava Isolation during Catheter Ablation for Atrial Fibrillation and Atrial Flutter

Chen, Gang; Dong, Jian; Liu, Xing Peng; Zhang, Xin Yong; Long, De Yong; Sang, Cai Hua; Ning, Man; Tang, Ruiyi; Jiang, Chen Xi; Sheng, Chang

doi:10.1111/j.1540-8159.2010.02903.x

Cited by 44 publications

(51 citation statements)

References 16 publications

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“…Complications, such as SN injury, PN injury, and SVC stenosis, were observed in RF ablation of SVC 17‐19 . During the RF ablation of SVC, especially the posterolateral part of SVC, ablation should be avoided if PN could be captured by high‐out pacing at the ablation site.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Lastly, SVC stenosis could occur, although prevention is possible through a signal segmental approach and 3D CARTO geometry, in order to stay in close proximity to the SVC ostium [11][12][13]26]. If necessary, therefore, SVCI should be performed below the level of both the SVC triggers and the phrenic nerve capture site, and above the level of the sinus node origin [27][28][29].…”

Section: Potential Complications Related To Superior Vena Cava Isolatmentioning

confidence: 97%

Remote-controlled magnetic pulmonary vein isolation combined with superior vena cava isolation for paroxysmal atrial fibrillation: A prospective randomized study

Costa

Levallois

Romeyer‐Bouchard

et al. 2015

Archives of Cardiovascular Diseases

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“…Thus, an SVC isolation (SVCI) is considered to improve the rhythm outcome in patients with those foci [6]. However, the following procedural complications have also been documented after and during an SVCI: sinus node injury, right phrenic nerve injury, and SVC stenosis [7], [8], [9]. Therefore, the assessment of the arrhythmogenicity of the SVC would be necessary before the procedure.…”

Section: Introductionmentioning

confidence: 99%

Anatomical dilatation of the superior vena cava associated with an arrhythmogenic response induced by SVC scan pacing after atrial fibrillation ablation

Fukuzawa

Kiuchi

Matsumoto

et al. 2016

Journal of Arrhythmia

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BackgroundThe relationship between pulmonary vein (PV) arrhythmogenicity and its anatomy has been reported. However, that of the superior vena cava (SVC) has not been well discussed. Arrhythmogenic response induced by pacing stimulation at SVC might help with identifying SVC arrhythmogenicity. The purpose of this study was to investigate the relationship between the anatomical dilatation of SVC and the arrhythmogenic response induced by pacing at SVC.MethodsForty-three patients who underwent atrial fibrillation (AF) ablation were enrolled in this study. After PV isolation, scan pacing (up to triple extra stimulation following intrinsic sinus beats) was performed at SVC. The arrhythmogenic response was defined as following: (1) repetitive atrial responses, (2) non-sustained, and (3) sustained AF/ atrial tachycardia. To assess the dilatation of SVC, we measured the cross-sectional area of the SVC (SVC-area) using multi-planar reconstruction CT imaging.ResultsArrhythmogenic responses were documented in 24 patients (Group 1). No arrhythmogenic responses were documented in the remaining 19 patients (Group 2). The SVC-area was significantly larger in Group 1 than Group 2 (3.1±0.9 vs. 2.2±0.8 cm2, P=0.004). A multivariate analysis revealed only SVC-area was associated with arrhythmogenic responses (odds ratio=2.87, CI 1.05–7.82, P=0.04). Furthermore, AF recurrence rate was significantly higher in patients with SVC-area>2.56 cm2 than those with SVC-area <2.56 cm2 (9 [42.9%] of 21 vs. 3 [13.6%] of 22, P=0.026).ConclusionDilatation of SVC was associated with an arrhythmogenic response, and the AF recurrence rate was significantly higher in patients with large SVC-area. Adjunctive catheter intervention for the SVC might be indicated in patients with a dilated SVC and an arrhythmogenic response.

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Sinus Node Injury as a Result of Superior Vena Cava Isolation during Catheter Ablation for Atrial Fibrillation and Atrial Flutter

Abstract: Sinus node may be damaged due to the ablation sites closer to sinus node. The definition of the junction of right atrium and SVC is very important, the ablation sites of anterolateral free wall of the SVC should not be too close to the SVC orifice.

Cited by 44 publications

References 16 publications

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

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

Remote-controlled magnetic pulmonary vein isolation combined with superior vena cava isolation for paroxysmal atrial fibrillation: A prospective randomized study

Anatomical dilatation of the superior vena cava associated with an arrhythmogenic response induced by SVC scan pacing after atrial fibrillation ablation

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