A novel approach for effective superior vena cava isolation using the CARTO electroanatomical mapping system

• Published in: Journal of arrhythmia Vol. 37; no. 5; pp. 1295 - 1302
• Main Authors: Inagaki, Dai, Fukamizu, Seiji, Tokioka, Sayuri, Kimura, Takashi, Takahashi, Masao, Kitamura, Takeshi, Hojo, Rintaro
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.10.2021; John Wiley and Sons Inc; Wiley
• Subjects: Ablation; atrial fibrillation; CARTO system; Catheters; extended early meets late; lower threshold; Medical equipment and supplies industry; Medical research; Medical test kit industry; Medicine, Experimental; Original; superior vena cava isolation; Visualization; United States; atrial fibrillation; CARTO system; lower threshold; extended early meets late; superior vena cava isolation
• ISSN: 1880-4276; 1883-2148
• DOI: 10.1002/joa3.12615

Background Previous studies have demonstrated that some patients have spontaneous right atrium (RA)‐superior vena cava (SVC) conduction block, which could be utilized to isolate the SVC effectively by using the Rhythmia mapping system (Boston Scientific). However, employing this approach for SVC isolation using the CARTO electroanatomical mapping system (Biosense Webster) has not yet been clarified. This study aimed to evaluate the safety and efficacy of SVC isolation using the extended early meets late (EEML) tool with the CARTO system. Methods The patients who underwent SVC isolation using the CARTO system were enrolled in this study. The RA‐SVC conduction block was visualized with an EEML tool. We prospectively assessed the safety and efficacy of SVC isolation using this system. Results We analyzed 54 patients, and all SVCs were successfully isolated with no complications. Altogether, 44 patients (81.5%) had spontaneous RA‐SVC conduction block, and the remaining 10 patients (18.5%) did not. The block group required fewer radiofrequency deliveries for the SVC isolation than the nonblock group (10.7 ± 5.0 vs 15.5 ± 4.8, P = .009). The size of the isolated area in the block group was larger than that in the nonblock group (15.2 ± 5.1 cm2 vs 12.4 ± 2.5 cm2, P = .017). Conclusions Approximately 80% of the patients in this study developed a spontaneous RA‐SVC conduction block, which might contribute to shortening the time of ablation and avoiding complications. In our study, spontaneous RA‐SVC conduction block was observed in approximately 80% of the patients. The block group required fewer RF deliveries for SVC isolation than the non‐block group and the procedural time to SVC isolation in the block group was significantly less than in the non‐block group. The size of the isolated area in the block group was larger than that in the non‐block group.