Superior vena cava is associated with improved outcomes in atrial fibrillation ablation, as part of a patient- tailored approach: a systematic review and meta-analysis
M Botis, D Tsiachris, I Doundoulakis, A Kordalis, C K Antoniou, S Chiotis, A E Karanikola, G B Chierchia, C De Asmundis, K TsioufisAbstract
Background
Pulmonary vein (PV) isolation is the mainstay in atrial fibrillation (AF) ablation. However, additional arrhythmogenic foci seem to contribute to AF initiation and maintenance. A great proportion of those non-PV foci have been reported to be located in the superior vena cava.
Purpose
We aimed to investigate the effectiveness of SVC isolation as an adjunctive therapy to PV isolation.
Methods
We performed a systematic review of MEDLINE and CENTRAL. Inclusion criteria were cohort studies with control group or randomized clinical trials, comparing patients undergoing AF ablation without additional SVC isolation to those receiving ablation with concurrent SVC isolation, in effects of freedom from atrial tachycardia.
Results
A total of 10 studies, incorporating 2.176 patients, were included. The majority of the patients (91.5%) expressed paroxysmal AF. The additional SVC isolation strategy in patients undergoing AF ablation was more effective than the non- SVC isolation strategy (odds ratio = 0.71; 95% confidence interval, 0.55-0.92). In a subgroup analysis, radiofrequency ablation demonstrated effectiveness (odds ratio = 0.69; 95% confidence interval, 0.53-0.92). Conversely, the use of cryoablation did not alter clinical outcomes (odds ratio = 0.69; 95% confidence interval, 0.13- 3.61). In a distinct subgroup analysis, SVC isolation guided by induction of SVC-originating AF triggers—versus no isolation when no AF-inducing triggers were observed- yielded no superiority (OR = 0.73; 95% confidence interval, 0.46–1.16).
Conclusions
The outcomes of AF ablation are favorable when additional SVC isolation is conducted. In a tailored care approach, radiofrequency energy should be preferred, and periprocedural induction of SVC-originating AF triggers should not be used as a criterion for performing SVC isolation. These findings support integrating SVC isolation into individualized ablation strategies to optimize patient outcomes.Figure 1Figure 2