Conventional versus modified superior vena cava ablation for atrial fibrillation: efficiency and recurrent burden

The superior vena cava (SVC) is one of the most important non-pulmonary vein origins of atrial fibrillation (AF). Careful treatment is required to reduce AF recurrence following ablation. Previous SVC ablation strategies have had relatively low success rates, longer procedure times, and an increased risk of serious complications. Therefore, we propose a modified approach to improve the feasibility of SVC isolation (SVCI).

A total of 234 patients with AF were divided into two groups. Group A (108 patients) underwent SVCI using a conventional approach, while group B (126 patients) underwent a modified three-step ablation approach. The modified SVC ablation plane was located 0.5-1 cm above the intersection of the right superior pulmonary vein (RSPV) and the left atrium (LA) roof in the posterior-anterior (PA) view. SVCI was avoided at sites with phrenic nerve (PN) capture.

There were fewer sites of ablation in group B than in group A (11.8 ± 4.7 versus 18.0 ± 7.1). Group B had significantly shorter radiofrequency time and total time of SVCI. Additionally, group B had a much lower incidence of PN injury. During a mean follow-up period of 35.0 ± 0.7 months, patients in group A had a lower AF recurrence-free rate compared to those in group B (75.0% and 86.2%, respectively; log-rank p < .005) after initial ablation.

The modified SVCI approach demonstrates greater efficiency and a lower recurrence rate than the conventional approach, making it a potentially superior ablation strategy.