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Impact of Persistent Left Superior Vena Cava on Outcomes With Atrial Fibrillation Ablation
Claire Sorensen1, Ahmed Shahab2, Jinxiang Hu3
1Department of Medical Education, University of Kansas School of Medicine, Kansas City, Kansas, USA.
Insights
Persistent left superior vena cava (PLSVC) is linked to lower atrial fibrillation (AF) recurrence after ablation. Repeat ablation significantly improves freedom from AF in PLSVC patients, suggesting its potential benefit.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Persistent left superior vena cava (PLSVC) is an anatomical variation that can be associated with atrial fibrillation (AF).
- Understanding the impact of PLSVC on AF ablation outcomes is crucial for patient management.
Purpose of the Study:
- To compare the 1-year freedom from recurrent atrial tachycardia (AT) or AF after ablation in patients with PLSVC versus a matched cohort without PLSVC (n-PLSVC).
Main Methods:
- Retrospective, case-control study (2008-2022) involving 15 PLSVC patients and 75 matched controls.
- Propensity score matching was used to control for variables including age, sex, BMI, AF type, ablation energy, and left atrial volume.
- Exclusion criteria included less than 1 year of follow-up or prior surgical ablation.
Main Results:
- One-year freedom from AF was significantly lower in PLSVC patients (27%) compared to n-PLSVC controls (59%, p=0.02).
- Of PLSVC patients, 33% underwent direct ablation of the PLSVC, all experiencing recurrent AT/AF within a year.
- Repeat AF ablation in PLSVC patients achieved 83% freedom from AF at a median follow-up of 2.1 years.
Conclusions:
- Patients with PLSVC exhibit lower initial freedom from AF post-ablation compared to those without.
- Repeat ablation procedures can significantly improve long-term freedom from AF in PLSVC patients.
- Further research is needed to optimize ablation strategies for PLSVC, including the potential role of pulse-field ablation.
Background:
A persistent left superior vena cava (PLSVC) can be a trigger for atrial fibrillation (AF).
Objective:
We aimed to compare post-ablation 1-year freedom from recurrent atrial tachycardia (AT)/AF in PLSVC patients with a matched population without PLSVC (n-PLSVC).
Methods:
A single-center, retrospective, case-control study between 2008 and 2022. Pre-ablation imaging identified patients with PLSVC. Propensity score matching for age, sex, BMI, type of AF, AF ablation energy type, left atrial volume, and year of ablation was performed to identify five controls for each PLSVC patient. We excluded patients who had less than 1 year of follow-up post-ablation or underwent prior surgical ablation.
Results:
There were 90 total patients including 15 PLSVC patients and 75 matched controls (60 ± 10 years old, 31% women, 58% paroxysmal, 62% radiofrequency). One-year freedom from AF was lower with PLSVC (27%) than n-PLSVC (59%, p = 0.02). The PLSVC was targeted for ablation in 5/15 patients (33%), all of whom had recurrent AT/AF within 1 year. Redo AF ablations were performed in 40% (6/15) of PLSVC patients. Freedom from AF at last follow-up (median 2.1, IQR 0.5-4.0 years) was 83% in PLSVC patients who underwent redo ablation. The only complication was right atrial lead dysfunction post-ablation requiring lead revision.
Conclusion:
Although the post-ablation freedom from AF is lower in patients with PLSVC than n-PLSVC, repeat ablation can result in a high freedom from AF in patients with PLSVC. Further study is necessary to determine the optimal methods and role for PLSVC ablation (including the role for pulse-field ablation).
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