Introduction: In patients with non-paroxysmal AF, various ablation
strategies have been attempted to target non-pulmonary vein (PV) foci or
to achieve substrate modification beyond pulmonary vein isolation (PVI).
The efficacy of empirical ablation of the SVC, one of the most common
non-PV foci, is unclear. The aim of this study was to investigate the
efficacy and safety of additional superior vena cava (SVC) isolation in
patients with non-paroxysmal atrial fibrillation (AF) undergoing
thoracoscopic surgical ablation. Methods and Results: A total of 191
patients with persistent or longstanding persistent AF was enrolled. All
patients underwent total thoracoscopic surgical ablation for AF, and
half of them also received empirical SVC isolation. We compared the
atrial-tachyarrhythmia (ATa)-free survival rate and procedure-related
complications in the two groups of patients. The 3-year ATa-free
survival rate was 53% in the SVC-isolation group and 52% in the
no-SVC-isolation group, (p = 0.644). There were no differences between
the two groups with respect to AF type or LA size. Procedure-related
complications occurred in 12 patients (6%). Pacemakers were implanted
only in 3 patients from the SVC-isolation group. The only factor
influencing recurrence of ATa was LA diameter. Conclusions: Empirical
SVC isolation during thoracoscopic ablation for persistent AF did not
improve patient outcomes.
Transseptal puncture and catheter ablation via the superior vena cava approach for persistent atrial fibrillation in a patient with polysplenia syndrome and interruption of the inferior vena cava: contact force–guided pulmonary vein isolation