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Efficacy, Safety and Feasibility of Superior Vena Cava Isolation in Patients Undergoing Atrial Fibrillation Catheter Ablation: An Up-to-Date Review

Pulmonary vein isolation (PVI) is the cornerstone in atrial fibrillation (AF) ablation; yet, the role of arrhythmogenic superior vena cava (SVC) is increasingly recognized and different ablation strategies have been employed in this context. SVC can act as a trigger or perpetuator of AF, and its sig...

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Autores principales: Vrachatis, Dimitrios A., Papathanasiou, Konstantinos A., Kossyvakis, Charalampos, Giotaki, Sotiria G., Deftereos, Gerasimos, Kousta, Maria S., Iliodromitis, Konstantinos E., Bogossian, Harilaos, Avramides, Dimitrios, Giannopoulos, George, Lambadiari, Vaia, Siasos, Gerasimos, Papaioannou, Theodore G., Deftereos, Spyridon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10136264/
https://www.ncbi.nlm.nih.gov/pubmed/37189639
http://dx.doi.org/10.3390/biomedicines11041022
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author Vrachatis, Dimitrios A.
Papathanasiou, Konstantinos A.
Kossyvakis, Charalampos
Giotaki, Sotiria G.
Deftereos, Gerasimos
Kousta, Maria S.
Iliodromitis, Konstantinos E.
Bogossian, Harilaos
Avramides, Dimitrios
Giannopoulos, George
Lambadiari, Vaia
Siasos, Gerasimos
Papaioannou, Theodore G.
Deftereos, Spyridon
author_facet Vrachatis, Dimitrios A.
Papathanasiou, Konstantinos A.
Kossyvakis, Charalampos
Giotaki, Sotiria G.
Deftereos, Gerasimos
Kousta, Maria S.
Iliodromitis, Konstantinos E.
Bogossian, Harilaos
Avramides, Dimitrios
Giannopoulos, George
Lambadiari, Vaia
Siasos, Gerasimos
Papaioannou, Theodore G.
Deftereos, Spyridon
author_sort Vrachatis, Dimitrios A.
collection PubMed
description Pulmonary vein isolation (PVI) is the cornerstone in atrial fibrillation (AF) ablation; yet, the role of arrhythmogenic superior vena cava (SVC) is increasingly recognized and different ablation strategies have been employed in this context. SVC can act as a trigger or perpetuator of AF, and its significance might be more pronounced in patients undergoing repeated ablation. Several cohorts have examined efficacy, safety and feasibility of SVC isolation (SVCI) among AF patients. The majority of these studies explored as-needed SVCI during index PVI, and only a minority of them included repeated ablation subjects and non-radiofrequency energy sources. Studies of heterogeneous design and intent have explored both empiric and as-needed SVCI on top of PVI and reported inconclusive results. These studies have largely failed to demonstrate any clinical benefit in terms of arrhythmia recurrence, although safety and feasibility are undisputable. Mixed population demographics, small number of enrollees and short follow-up are the main limitations. Procedural and safety data are comparable between empiric SVCI and as-needed SVCI, and some studies suggested that empiric SVCI might be associated with reduced AF recurrences in paroxysmal AF patients. Currently, no study has compared different ablation energy sources in the setting of SVCI, and no randomized study has addressed as-needed SVCI on top of PVI. Furthermore, data regarding cryoablation are still in their infancy, and regarding SVCI in patients with cardiac devices more safety and feasibility data are needed. PVI non-responders, patients undergoing repeated ablation and patients with long SVC sleeves could be potential candidates for SVCI, especially via an empiric approach. Although many technical aspects remain unsettled, the major question to answer is which clinical phenotype of AF patients might benefit from SVCI?
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spelling pubmed-101362642023-04-28 Efficacy, Safety and Feasibility of Superior Vena Cava Isolation in Patients Undergoing Atrial Fibrillation Catheter Ablation: An Up-to-Date Review Vrachatis, Dimitrios A. Papathanasiou, Konstantinos A. Kossyvakis, Charalampos Giotaki, Sotiria G. Deftereos, Gerasimos Kousta, Maria S. Iliodromitis, Konstantinos E. Bogossian, Harilaos Avramides, Dimitrios Giannopoulos, George Lambadiari, Vaia Siasos, Gerasimos Papaioannou, Theodore G. Deftereos, Spyridon Biomedicines Review Pulmonary vein isolation (PVI) is the cornerstone in atrial fibrillation (AF) ablation; yet, the role of arrhythmogenic superior vena cava (SVC) is increasingly recognized and different ablation strategies have been employed in this context. SVC can act as a trigger or perpetuator of AF, and its significance might be more pronounced in patients undergoing repeated ablation. Several cohorts have examined efficacy, safety and feasibility of SVC isolation (SVCI) among AF patients. The majority of these studies explored as-needed SVCI during index PVI, and only a minority of them included repeated ablation subjects and non-radiofrequency energy sources. Studies of heterogeneous design and intent have explored both empiric and as-needed SVCI on top of PVI and reported inconclusive results. These studies have largely failed to demonstrate any clinical benefit in terms of arrhythmia recurrence, although safety and feasibility are undisputable. Mixed population demographics, small number of enrollees and short follow-up are the main limitations. Procedural and safety data are comparable between empiric SVCI and as-needed SVCI, and some studies suggested that empiric SVCI might be associated with reduced AF recurrences in paroxysmal AF patients. Currently, no study has compared different ablation energy sources in the setting of SVCI, and no randomized study has addressed as-needed SVCI on top of PVI. Furthermore, data regarding cryoablation are still in their infancy, and regarding SVCI in patients with cardiac devices more safety and feasibility data are needed. PVI non-responders, patients undergoing repeated ablation and patients with long SVC sleeves could be potential candidates for SVCI, especially via an empiric approach. Although many technical aspects remain unsettled, the major question to answer is which clinical phenotype of AF patients might benefit from SVCI? MDPI 2023-03-27 /pmc/articles/PMC10136264/ /pubmed/37189639 http://dx.doi.org/10.3390/biomedicines11041022 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Vrachatis, Dimitrios A.
Papathanasiou, Konstantinos A.
Kossyvakis, Charalampos
Giotaki, Sotiria G.
Deftereos, Gerasimos
Kousta, Maria S.
Iliodromitis, Konstantinos E.
Bogossian, Harilaos
Avramides, Dimitrios
Giannopoulos, George
Lambadiari, Vaia
Siasos, Gerasimos
Papaioannou, Theodore G.
Deftereos, Spyridon
Efficacy, Safety and Feasibility of Superior Vena Cava Isolation in Patients Undergoing Atrial Fibrillation Catheter Ablation: An Up-to-Date Review
title Efficacy, Safety and Feasibility of Superior Vena Cava Isolation in Patients Undergoing Atrial Fibrillation Catheter Ablation: An Up-to-Date Review
title_full Efficacy, Safety and Feasibility of Superior Vena Cava Isolation in Patients Undergoing Atrial Fibrillation Catheter Ablation: An Up-to-Date Review
title_fullStr Efficacy, Safety and Feasibility of Superior Vena Cava Isolation in Patients Undergoing Atrial Fibrillation Catheter Ablation: An Up-to-Date Review
title_full_unstemmed Efficacy, Safety and Feasibility of Superior Vena Cava Isolation in Patients Undergoing Atrial Fibrillation Catheter Ablation: An Up-to-Date Review
title_short Efficacy, Safety and Feasibility of Superior Vena Cava Isolation in Patients Undergoing Atrial Fibrillation Catheter Ablation: An Up-to-Date Review
title_sort efficacy, safety and feasibility of superior vena cava isolation in patients undergoing atrial fibrillation catheter ablation: an up-to-date review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10136264/
https://www.ncbi.nlm.nih.gov/pubmed/37189639
http://dx.doi.org/10.3390/biomedicines11041022
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