Predictors of ectopic firing from the superior vena cava in patients with paroxysmal atrial fibrillation

• Published in: Journal of interventional cardiac electrophysiology Vol. 42; no. 1; pp. 27 - 32
• Main Authors: Inada, Keiichi, Matsuo, Seiichiro, Tokutake, Ken-ichi, Yokoyama, Ken-ichi, Hioki, Mika, Narui, Ryohsuke, Ito, Keiichi, Tanigawa, Shin-ichi, Yamashita, Seigo, Tokuda, Michifumi, Shibayama, Kenri, Miyanaga, Satoru, Sugimoto, Ken-ichi, Yoshimura, Michihiro, Yamane, Teiichi
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.01.2015; Springer Nature B.V
• Subjects: Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - surgery; Atrial Premature Complexes - diagnosis; Atrial Premature Complexes - epidemiology; Atrial Premature Complexes - prevention & control; Body Surface Potential Mapping - statistics & numerical data; Cardiology; Catheter Ablation - utilization; Female; Humans; Japan - epidemiology; Male; Medicine; Medicine & Public Health; Middle Aged; Prognosis; Recurrence; Risk Assessment; Risk Factors; Treatment Outcome; Vena Cava, Superior - surgery; Japan; Predictor; Superior vena cava; Atrial fibrillation; Catheter ablation; Ectopic firing
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-014-9954-3

Purpose Although catheter ablation targeting the pulmonary vein (PV) is a well-known therapy for patients with paroxysmal atrial fibrillation (PAF), ectopic firings from the superior vena cava (SVC) can initiate PAF. The purpose of this study was to investigate predictors of SVC firing. Methods The subjects included 336 consecutive PAF patients (278 males, age 56.1 ± 10.8 years) undergoing atrial fibrillation (AF) ablation. The appearance of SVC firing was monitored throughout the procedure using a decapolar catheter with multiple electrodes to record electrograms of the coronary sinus and SVC. In addition to PV isolation, SVC isolation was performed only in patients with documented SVC firing. Results SVC firing was observed in 43/336 (12.8 %) of the patients, among whom complete isolation of the SVC was achieved in 40/43 (93 %) patients. A lower body mass index (BMI) (22.8 ± 2.8 vs 24.1 ± 3.1 kg/m 2 , p  = 0.007) and higher prevalence of prior ablation procedures (58 vs 18 %, p  = 0.0001) were related to the presence of SVC firing. In a multivariate analysis, a lower BMI ( p  = 0.012; odds ratio 0.83, 95 % CI 0.72 to 0.96) and history of prior ablation procedures ( p  < 0.0001; odds ratio 5.37, 95 % CI 2.71 to 10.63) were found to be independent predictors of the occurrence of SVC firing. Among 96 patients undergoing repeat ablation procedures, less PV-left atrial re-conduction was observed in patients with SVC firing than in those without (2.7 ± 1.2 vs 3.2 ± 0.8, p  = 0.02). Conclusions The presence of SVC firing in patients with PAF is associated with a history of repeat ablation procedures and lower BMI values.