Long-term Outcome of Catheter Ablation in Patients With AF
Long-term Outcome of Catheter Ablation in Patients With AF
Long-Term Outcome of SVC AF Ablation.
Introduction: Data of the long-term clinical outcome after superior vena cava (SVC) isolation are limited. We aimed to evaluate the long-term outcome in patients with atrial fibrillation (AF) who had triggers originating from the SVC and received catheter ablation of AF.
Methods and Results: The study consisted of 68 patients (age 56 ± 12 years old, 32 males) who underwent the ablation procedure for drug-refractory, symptomatic paroxysmal AF originating from the SVC since 1999. Group 1 consisted of 37 patients with AF initiated from the SVC only, and group 2 consisted of 31 patients with both SVC and pulmonary vein (PV) triggers. During a follow-up period of 88 ± 50 months, the AF recurrence rate was 35.3% after a single procedure. The freedom-from-AF rates were 85.3% at 1 year and 73.3% at 5 years. In the baseline study, group 2 had larger left atrium (38 ± 4 mm vs 36 ± 5 mm, P = 0.04), left ventricle (50 ± 5 mm vs 46 ± 5 mm, P = 0.003), and PV diameters. Kaplan–Meier survival analysis showed a higher AF recurrence rate in group 2 compared to that in group 1 (P = 0.012). The independent predictor of an AF recurrence was a larger SVC diameter (P = 0.02, HR 1.4, 95% CI 1.1–1.8).
Conclusion: Among the patients with paroxysmal AF originating from the SVC, 73% remained free of AF for 5 years after a single catheter ablation procedure. Superior vena cava isolation without PV isolation is an acceptable therapeutic strategy in those patients with AF originating from the SVC only. The SVC diameter was an independent predictor of AF recurrence.
The pulmonary veins (PVs) are thought to be the major source of ectopic foci initiating atrial fibrillation (AF). However, several studies also demonstrated the importance of extra-PV ectopic foci initiating AF, including the superior vena cava (SVC), left atrial posterior free wall, crista terminalis, coronary sinus ostium, ligament of Marshall, and interatrial septum. Of these, the incidence of SVC ectopy initiating AF was 37%, and SVC isolation in addition to PV isolation could reduce the recurrence of AF. In a 1-year follow-up after SVC isolation for SVC-initiating AF, previous studies showed the freedom-from-AF rates were 74–100%. However, the results of the long-term clinical outcome are limited. We aimed to evaluate the long-term outcome in patients with drug-refractory symptomatic AF who had triggers originating from the SVC and received catheter ablation for AF.
Abstract and Introduction
Abstract
Long-Term Outcome of SVC AF Ablation.
Introduction: Data of the long-term clinical outcome after superior vena cava (SVC) isolation are limited. We aimed to evaluate the long-term outcome in patients with atrial fibrillation (AF) who had triggers originating from the SVC and received catheter ablation of AF.
Methods and Results: The study consisted of 68 patients (age 56 ± 12 years old, 32 males) who underwent the ablation procedure for drug-refractory, symptomatic paroxysmal AF originating from the SVC since 1999. Group 1 consisted of 37 patients with AF initiated from the SVC only, and group 2 consisted of 31 patients with both SVC and pulmonary vein (PV) triggers. During a follow-up period of 88 ± 50 months, the AF recurrence rate was 35.3% after a single procedure. The freedom-from-AF rates were 85.3% at 1 year and 73.3% at 5 years. In the baseline study, group 2 had larger left atrium (38 ± 4 mm vs 36 ± 5 mm, P = 0.04), left ventricle (50 ± 5 mm vs 46 ± 5 mm, P = 0.003), and PV diameters. Kaplan–Meier survival analysis showed a higher AF recurrence rate in group 2 compared to that in group 1 (P = 0.012). The independent predictor of an AF recurrence was a larger SVC diameter (P = 0.02, HR 1.4, 95% CI 1.1–1.8).
Conclusion: Among the patients with paroxysmal AF originating from the SVC, 73% remained free of AF for 5 years after a single catheter ablation procedure. Superior vena cava isolation without PV isolation is an acceptable therapeutic strategy in those patients with AF originating from the SVC only. The SVC diameter was an independent predictor of AF recurrence.
Introduction
The pulmonary veins (PVs) are thought to be the major source of ectopic foci initiating atrial fibrillation (AF). However, several studies also demonstrated the importance of extra-PV ectopic foci initiating AF, including the superior vena cava (SVC), left atrial posterior free wall, crista terminalis, coronary sinus ostium, ligament of Marshall, and interatrial septum. Of these, the incidence of SVC ectopy initiating AF was 37%, and SVC isolation in addition to PV isolation could reduce the recurrence of AF. In a 1-year follow-up after SVC isolation for SVC-initiating AF, previous studies showed the freedom-from-AF rates were 74–100%. However, the results of the long-term clinical outcome are limited. We aimed to evaluate the long-term outcome in patients with drug-refractory symptomatic AF who had triggers originating from the SVC and received catheter ablation for AF.
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