Abstract 13447: Superior Vena Cava Isolation From the Right Atrial Posterior Wall: A Case Series
Introduction: Superior vena cava (SVC) isolation is a common ablation strategy to address non-pulmonary vein triggers in patients with paroxysmal and non-paroxysmal AF. SVC isolation with circumferential ablation might be difficult to achieve because of the phrenic nerve (PN) location in its anterolateral aspect.
Hypothesis: It is possible to isolate the SVC sparing its anterolateral aspect given the presence of preferential conduction from the posterior wall of the right atrium (RA) to the SVC.
Methods: Consecutive patients in which SVC isolation ablating in the RA posterior wall. RF ablation was started in the septal aspect of the SVC-RA junction and it was continued posteriorly-inferiorly in sites of early activation (relative to the SVC) until electrical isolation was obtained. The distance between the SVC-RA junction and the site of SVC isolation was measured with 3D electro-anatomical mapping.
Results: 85 patients were included in the analysis. 27% were females, with a mean age of 66 ± 10 years, 21% had paroxysmal AF, 42% persistent AF, 36% longstanding persistent AF. The procedure was a repeat ablation in 58% of the cases, with a mean procedure time of 124 ± 38 minutes.
Acute SVC isolation was achieved in 98%. Mean distance of isolation from the SVC-RA junction was 19.9 ± 5.1 mm (range 10.2-32.1 mm).
At follow-up, we observed 2 (2%) transient PN injuries. After this, we began performing PN mapping in the PW, which precluded complete SVC isolation in 1 case (see Figure 2).
Conclusions: SVC isolation can be achieved without circumferential ablation by targeting sites with early activation (relative to the SVC) in the RA posterior wall.
- Ablation, radiofrequency
- Arrhythmias, treatment of
- Atrial fibrillation
- Atrial arrhythmias
- Supraventricular tachycardia
Author Disclosures: C. Gianni: None. S. Mohanty: None. C. Trivedi: None. R. Bai: None. A. Al-Ahmad: None. J.D. Burkhardt: None. G.J. Gallinghouse: None. P.M. Hranitzky: None. R.P. Horton: None. J.E. Sanchez: None. L. Di Biase: None. A. Natale: None.
- © 2016 by American Heart Association, Inc.