SVC Mapping Using an Ultra-High Resolution 3-Dimensional Mapping System in Patients With and Without AF

Miyazaki, Shinsuke; Yamao, Kazuya; Hasegawa, Kanae; Ishikawa, Eri; Mukai, Moe; Aoyama, Daisetsu; Kaseno, Kenichi; Iesaka, Yoshito; Tada, Hiroshi

doi:10.1016/j.jacep.2019.05.024

Cited by 9 publications

(15 citation statements)

References 15 publications

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“…The explanation for a failed procedure with cryoenergy or with RF could be related to issues pointed out by Kholova et al, describing the presence of myocardial sleeves from the RA to the SVC with a mean length of approximately 14 ± 14 mm, and more important, with a mean thickness of 1.2 ± 1.0 mm (maximum 4 mm), all localized on the outer side of the venous adventitia and in many cases with an interlayer of fatty or fibrofatty tissue between the atrial extension and the adventitia. In another recent article by Miyazaki et al using high‐density mapping, the mean length of the electrically activated SVC sleeve was 27 mm, the longest length being found in the anteroseptal SVC region with asymmetric distribution. In some patients, the distribution and thickness of the myocardial sleeves in the SVC did not allow them to be isolated with cryoballoon energy due to their length or the presence of fibrofatty tissue, though this explanation remains speculative.…”

Section: Discussionmentioning

confidence: 94%

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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Section: Discussionmentioning

confidence: 94%

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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“…The optimal settings for the power and duration of the RF energy have not been determined for the SVC ablation. Conventionally, a power of 20–30 W has been frequently used, 21,26 and the ablation has been limited to settings of 10–20 W for up to 20–30 s at sites close to the right PN 26,27 . In the present study, we referred to the study of ablation lesion characteristics conducted with a variable power and duration to determine the RF delivery settings in the HPSD group.…”

Section: Discussionmentioning

confidence: 99%

“…Conventionally, a power of 20-30 W has been frequently used, 21,26 and the ablation has been limited to settings of 10-20 W for up to 20-30 s at sites close to the right PN. 26,27 In the present study, we referred to the study of ablation lesion characteristics conducted with a variable power and duration to determine the RF delivery settings in the HPSD group. Borne et al showed that in the ex vivo model, the average maximum depth of the ablation lesion for a CF of 10 g with 50 W for 15 s was two times that with 20 W for 30 s (1.8 ± 0.5 and 0.9 ± 0.2 mm).…”

Section: Ablation Settings For the Svci With An Hpsd Ablation: Consideration Based On Pre-clinical Studiesmentioning

confidence: 99%

Superior vena cava isolation with 50 W high power, short duration ablation strategy

Kusa

Sato

Hara

et al. 2021

Cardiovasc electrophysiol

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Introduction The optimal ablation strategy is unknown regarding a superior vena cava isolation (SVCI). This study aimed to examine the feasibility and safety and to analyze the lesion characteristics of the SVCI using high‐power, short‐duration (HPSD) ablation. Methods and Results A total of 100 patients underwent an index SVCI using HPSD (n = 50, HPSD group) or conventional lower‐power and longer‐duration (n = 50, LPLD group) ablation, using the Thermocool Smarttouch SF. In the HPSD group, ablation was performed with a power of 50 W for 7 s, and was limited to 4 s at the lateral segment close to the right phrenic nerve. The ablation setting used in the LPLD group was 20–25 W for 20–30 s and was limited to 10–20 W for 15–30 s at the lateral segment when diaphragmatic capture was seen. An electrical SVCI was achieved in all patients. The HPSD group required a significantly shorter procedure time (10.8 ± 3.2 vs. 14.8 ± 6.4 min; p < .01), shorter radiofrequency duration (49 ± 16 vs. 282 ± 124 s; p < .01), fewer lesions (8.3 ± 2.5 vs. 10.4 ± 4.4; p < .01), and lower ablation index (316 ± 38 vs. 356 ± 62; p < .001) than the LPLD group. The incidence of a postprocedural asymptomatic mild diaphragmatic elevation was comparable (2% in the HPSD group vs. 6% in the LPLD group; p = .61). Conclusion The 50‐W HPSD ablation strategy allowed for a successful, fast, and safe SVCI with the fewer ablation lesions and the lower ablation index.

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“…The previous SVC mapping reports using ultrahigh resolution mapping with a 64-pole basket catheter obtained 2478-3176 points in 7.1 to 10.8 min. [6][7][8] We used a 20-pole catheter to obtain 1296 ± 631 points in 4.6 ± 1.8 min, thus the procedure time of this study was acceptable.…”

Section: Electrophysiological and Anatomical Definition Of Ra-svc Jmentioning

confidence: 99%

“…3,5 The difference in the electrophysiological properties between the SVC and sinus node (SN) have recently been described using ultrahigh resolution mapping. [6][7][8] Most of those reports defined the right atrium (RA)-SVC junction using a horizontal line according to the anatomy. 6,7 However, Tanaka et al 8 reported that conduction block is observed at a diagonal RA-SVC junction in almost half the patients.…”

Section: Introductionmentioning

confidence: 99%

Electrophysiological identification of superior vena cava: Novel insight into slow conduction or conduction block

Matsunaga‐Lee

Egami

Ukita

et al. 2020

Cardiovasc electrophysiol

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Introduction: It has not been clarified how to identify the electrophysiological junction between right atrium (RA) and superior vena cava (SVC). The aim of this study was to identify the electrophysiological RA-SVC junction according to slow conduction or conduction bock and to examine the electrophysiological SVC isolation procedure.Methods: Seventy-three consecutive atrial fibrillation patients who underwent SVC mapping using a CARTO 3 system were enrolled in this study. Slow conduction or conduction block between the RA and SVC was identified by adjusting the lower threshold criteria of the early meets late function and was described as a white line.The SVC isolation was performed along the white line and with pacing maneuvers to confirm direct SVC capture.Results: Activation mapping (1296 ± 631 points) was obtained in 66 patients (90%) in 4.6 ± 1.8 min. Slow conduction or conduction block was observed in all patients.The threshold for detecting slow conduction or conduction block was 24 ± 8 ms. The location of the electrophysiological RA-SVC junction was higher in the anterior portion (anterior-septal, anterior, and anterior-lateral) than in the posterior portion (posterior-septal, posterior, and posterior-lateral) (−2.3 ± 6.2 mm vs. 7.1 ± 6.3 mm, p < .001). The SVC isolation at the electrophysiological RA-SVC junction was successful in all patients without any injury to the sinus node function. Asymptomatic phrenic nerve injury was observed in three patients (4.5%). Conclusion:In all patients, the electrophysiological RA-SVC junction determined by slow conduction or conduction block was identified and the electrophysiological SVC isolation was performed successfully and safely.

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SVC Mapping Using an Ultra-High Resolution 3-Dimensional Mapping System in Patients With and Without AF

Cited by 9 publications

References 15 publications

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

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

Superior vena cava isolation with 50 W high power, short duration ablation strategy

Electrophysiological identification of superior vena cava: Novel insight into slow conduction or conduction block

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