Keelani Ahmad, Alothman Obaida, Borisov Georgi, Frommhold Markus, Bartoli Lorenzo, Abdelwahab Hytham, D'Ambrosio Gabriele, Shehri Sultan Al, Raffa Santi, Geller J Christoph
Arrhythmia Section, Division of Cardiology, Heart Center, Zentralklinik Bad Berka, Bad Berka, Germany.
Institute of Cardiology, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy.
J Cardiovasc Electrophysiol. 2025 Feb;36(2):359-366. doi: 10.1111/jce.16510. Epub 2024 Dec 10.
In patients with atrial arrhythmias originating from the superior vena cava (SVC), the use of radiofrequency energy to isolate the SVC is associated with a significant risk of injury both to the phrenic nerve and the sinus node. Pulsed field ablation (PFA) may overcome the disadvantages of thermal energy and improve both ablation efficacy and safety.
We report the feasibility, safety, and clinical efficacy of focal monopolar PFA in patients with the origin of their atrial arrhythmia in the SVC.
Nine patients (7 men, age 66 ± 8 years) with SVC-induced paroxysmal AF (n = 3), persistent AF (n = 5), or frequent premature atrial beats (n = 1) underwent SVC isolation using focal monopolar PFA.
Acute circumferential SVC isolation was achieved in all cases, using 22 Ampere (A) or 25 A in areas with or without phrenic capture, respectively. The safety profile was excellent: two patients had transient sinus arrest and two had transient phrenic nerve stunning. Sinus node and phrenic nerve function recovered during the procedure, and no permanent damage was observed at follow-up. Coronary vasospasm occurred (and quickly resolved after injection of nitroglycerin) in one patient during additional ablation of a focal atrial tachycardia at the coronary sinus ostium. Kidney function remained stable before and after ablation in all patients.
In this patient cohort with SVC-triggered atrial arrhythmia, isolation using focal monopolar PFA was feasible, effective, and safe. No permanent injury to the phrenic nerve or sinus node was observed.
在源于上腔静脉（SVC）的房性心律失常患者中，使用射频能量隔离SVC会有损伤膈神经和窦房结的重大风险。脉冲场消融（PFA）可能会克服热能的缺点，并提高消融疗效和安全性。
我们报告了局灶性单极PFA治疗起源于SVC的房性心律失常患者的可行性、安全性和临床疗效。
9例患者（7例男性，年龄66±8岁），其中3例为SVC诱发的阵发性房颤，5例为持续性房颤，1例为频发房性早搏，接受了局灶性单极PFA隔离SVC治疗。
所有病例均实现了急性环形SVC隔离，在有或无膈神经捕获的区域分别使用22安培（A）或25A。安全性良好：2例患者出现短暂性窦性停搏，2例出现短暂性膈神经麻痹。术中窦房结和膈神经功能恢复，随访未观察到永久性损伤。1例患者在冠状窦口局灶性房性心动过速额外消融期间发生冠状动脉痉挛（注射硝酸甘油后迅速缓解）。所有患者消融前后肾功能均保持稳定。
在这个SVC触发房性心律失常的患者队列中，使用局灶性单极PFA进行隔离是可行、有效且安全的。未观察到膈神经或窦房结的永久性损伤。
