Wide-Area Superior Vena Cava Isolation Using a Circular Pulsed Field Ablation Catheter Guided By Spontaneous...

Area of Science:

• Electrophysiology
• Cardiovascular Medicine
• Medical Technology

Background:

• The superior vena cava (SVC) is a common trigger for atrial fibrillation (AF).
• Adjunctive SVC isolation (SVCi) can decrease AF recurrence.
• Radiofrequency (RF) ablation for SVCi carries risks like phrenic nerve palsy (PNP) and sinus node dysfunction (SND).

Purpose of the Study:

• To evaluate the feasibility and efficacy of pulsed field ablation (PFA) for SVCi.
• To compare PFA with RF ablation for SVCi using spontaneous block lines.
• To assess complication rates and procedural efficiency of PFA versus RF ablation in SVCi.

Main Methods:

• A single-centre retrospective study of 85 patients undergoing adjunctive SVCi (45 RF, 40 PFA).
• Spontaneous block lines identified using the EnSite X mapping system guided ablation planning.
• Comparison of first-pass success, application number, procedure duration, and isolation area between PFA and RF groups.

Main Results:

• SVC isolation was achieved in all patients.
• PFA demonstrated higher first-pass success (97.5% vs. 84.4%), fewer applications (4.4 vs. 14.2), and shorter procedure duration (368s vs. 847s) compared to RF.
• Low and comparable AF recurrence rates (7.5% vs. 8.9%) and infrequent SVC reconnection were observed, with transient PNP in one PFA case and transient SND in PFA and RF cases, all resolving spontaneously.

Conclusions:

• Wide-area SVCi using a circular PFA catheter guided by spontaneous block lines is feasible and efficient.
• PFA significantly reduces procedure time and ablation burden compared to RF.
• PFA offers a safe, reproducible approach for adjunctive SVCi in AF ablation, maintaining comparable efficacy and low complication rates.