Long-Term Outcome of Additional Superior Vena Cava to Septal Linear Ablation in Catheter Ablation of Atrial Fibrillation

• Published in: Journal of the American Heart Association Vol. 8; no. 22; p. e013985
• Main Authors: Jin, Moo-Nyun, Lim, Byounghyun, Yu, Hee Tae, Kim, Tae-Hoon, Uhm, Jae-Sun, Joung, Boyoung, Lee, Moon-Hyoung, Hwang, Chun, Pak, Hui-Nam
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 19.11.2019; Wiley
• Subjects: Aged; atrial fibrillation; Atrial Fibrillation - surgery; Atrial Septum - surgery; Autonomic Nervous System; catheter ablation; Catheter Ablation - methods; Female; Ganglia, Autonomic - surgery; Heart - innervation; Heart Atria; Heart Rate; Humans; Male; Middle Aged; Operative Time; Original Research; Patient-Specific Modeling; Postoperative Complications - epidemiology; Pulmonary Veins - surgery; recurrence; superior vena cava; Treatment Outcome; Vena Cava, Superior - surgery; recurrence; superior vena cava; atrial fibrillation; catheter ablation
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.119.013985

Background We previously reported the benefit of linear ablation from the superior vena cava to the right atrial septum (SVC-L) within a year after circumferential pulmonary vein isolation (CPVI) in patients with paroxysmal atrial fibrillation (AF). We explored the long-term effects of SVC-L and its potential related mechanisms. Methods and Results Among 2140 consecutive patients with AF ablation, we included 614 patients (73.3% male, aged 57.8±10.7 years, 13.7% with persistent AF) who did not undergo an extra-pulmonary vein left atrial ablation after propensity score matching; of those, 307 had additional SVC-L and 307 had CPVI alone. We evaluated the heart rate variability and computational modeling study to explore mechanisms. Although the procedure time was longer in the SVC-L group than the CPVI group ( <0.001), the complication rates did not differ ( =0.560). During 40.5±24.4 months of follow-up, the rhythm outcome was significantly better in the SVC-L group than the CPVI group (log rank, <0.001). At 2-year follow-up of heart rate variability, a significantly higher mean heart rate ( =0.018) and a lower ratio of low/high-frequency components ( =0.011) were found with SVC-L than CPVI alone. In realistic in silico biatrial modeling, which reflected the electroanatomies of 10 patients, SVC-L significantly reduced biatrial dominant frequency compared with CPVI alone ( <0.001) and increased AF termination and defragmentation rates ( =0.033). Conclusions SVC-L ablation in addition to CPVI significantly improved the long-term rhythm outcome over 2 years after AF catheter ablation by mechanisms involving autonomic modulation and AF organization.