scholarly journals The effect of empirical superior vena cava isolation during total thoracoscopic ablation in patients with persistent atrial fibrillation

2021 ◽  
Author(s):  
Hee-jin Kwon ◽  
Dong Seop Jeong ◽  
Hye Ree Kim ◽  
Seung-Jung Park ◽  
Kyoung-Min Park ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Survival Rate ◽  
Pulmonary Vein ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Persistent Atrial Fibrillation ◽  
Surgical Ablation ◽  
Free Survival ◽  
Improve Patient

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.

scholarly journals The impact of an empiric superior vena cava isolation added to pulmonary vein isolation for non-paroxysmal atrial fibrillation associated with left atrial low voltage areas

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Omuro ◽  
Y Yoshiga ◽  
M Fukuda ◽  
T Kato ◽  
S Fujii ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Superior Vena Cava ◽  
Left Atrial ◽  
Low Voltage ◽  
Superior Vena ◽  
Vena Cava ◽  
Free Survival ◽  
Initial Session ◽  
The Impact

Abstract Introduction Left atrial low-voltage areas (LVAs) are associated with recurrence after radiofrequency catheter ablation of atrial fibrillation (AF). However, the impact of LVAs on recurrence after an empiric pulmonary vein isolation (PVI) plus superior vena cava isolation (SVCI) strategy for non-Paroxysmal AF (PAF) patients remains unclear. Purpose We evaluated the impact of LVAs on the recurrence of atrial tachyarrhythmias (ATs)/AF in patients who underwent an empiric SVCI added to the PVI for non-PAF. Methods We enrolled 153 consecutive patients with non-PAF who underwent a PVI alone (PVI group; n=51) or empiric PVI plus SVCI (PVI+SVCI group; n=102). Left atrial voltage maps were constructed during sinus rhythm to identify the LVAs (<0.5 mV). No patients underwent a substrate modification of the LVAs. We divided the patients into two groups based on the LVAs (with or without an LVA >5% of the left atrial surface area) and investigated the ATs/AF free survival rate after the initial and multiple procedures. Results LVAs were identified in 65% and 73% of the PVI and PVI + SVCI groups, respectively (P=0.319). In the PVI group, the 18-month ATs/AF-free survival was 61% of the patients without LVAs and 27% of patients with LVAs after the initial session (P=0.018) (Figure 1-A). Seventy-two percent of the patients without LVAs and 46% of those with LVAs were free from ATs/AF after multiple sessions (P=0.083) (Figure 1-B). In the PVI+SVCI group, 50% of the patients with LVAs and 61% of those without LVAs had no recurrence after the initial session (P=0.374) (Figure 2-A). Moreover, there was no significant difference in the 18-month ATs/AF-free survival between the patients with and without LVAs after multiple sessions (73% vs. 79%; P=0.520) (Figure 2-B). Conclusion A PVI alone strategy for non-PAF patients with LVAs had limited efficacy for the outcomes, even with multiple procedures. However, an SVCI may have the potential to compensate for an impaired outcome in patients with LVAs. Funding Acknowledgement Type of funding source: None

scholarly journals P Wave Morphology of an Arrhythmogenic Focus in Patients With Atrial Fibrillation Originating From a Pulmonary Vein or the Superior Vena Cava

2008 ◽  
Vol 72 (10) ◽  
pp. 1650-1657 ◽  
Author(s):  
Kimie Ohkubo ◽  
Ichiro Watanabe ◽  
Takeshi Yamada ◽  
Yasuo Okumura ◽  
Kenichi Hashimoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
P Wave ◽  
Wave Morphology
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