Castro-Urda Víctor, Segura-Dominguez Melodie, Jiménez-Sánchez Diego, Aguilera-Agudo Cristina, Vela-Martín Paula, Lorente-Ros Alvaro, García-Rodriguez Daniel, Sánchez-Ortiz David, Pham-Trung Chinh, García-Izquierdo Eusebio, Mingo-Santos Susana, Toquero-Ramos Jorge, Fernández-Lozano Ignacio
Electrophysiology Unit (V.C.-U., M.S.-D., D.J.-S., C.A.-A., P.V.-M., A.L.-R., D.G.-R., D.S.-O., C.P.-T., E.G.-I., J.T.-R., I.F.-L.), Cardiology Service, Hospital Electrophysiology Unit Puerta de Hierro, Madrid, Spain.
Cardiac Imaging Unit (S.M.-S.), Cardiology Service, Hospital Electrophysiology Unit Puerta de Hierro, Madrid, Spain.
Circ Arrhythm Electrophysiol. 2025 Jan;18(1):e012917. doi: 10.1161/CIRCEP.124.012917. Epub 2024 Dec 16.
Superior vena cava (SVC) has been considered a specific trigger in atrial fibrillation development.
We investigated the efficacy and safety of combining cryoballoon pulmonary vein isolation (PVI) with SVC ablation compared with PVI alone in 100 patients with paroxysmal or non-long-standing persistent atrial fibrillation. Patients were randomly assigned to either the PVI+SVC ablation group or the PVI-only group. Each patient was given a mobile device to record a daily ECG and detect atrial tachyarrhythmias.
The primary end point, freedom from any atrial tachyarrhythmia recurrence between 91 and 365 days post-catheter ablation, did not significantly differ between the 2 groups (62.9% versus 72%; =0.41). However, the PVI+SVC group exhibited higher rates of phrenic nerve paralysis (20.8% versus 6%; =0.003) and transient sinus node injury (18.8% versus 0%; =0.001) compared with the PVI-only group. The median burden of atrial tachyarrhythmia showed no significant difference (=0.91).
The addition of SVC ablation to PVI did not enhance freedom from atrial tachyarrhythmia at 12 months, and it led to increased complications. These findings do not support the routine inclusion of SVC ablation in cryoballoon procedures for first-time catheter ablation in patients with paroxysmal or non-long-standing persistent atrial fibrillation.
上腔静脉（SVC）被认为是心房颤动发生的一个特定触发因素。
我们调查了100例阵发性或非长期持续性心房颤动患者中，与单纯冷冻球囊肺静脉隔离术（PVI）相比，联合冷冻球囊肺静脉隔离术与上腔静脉消融术的有效性和安全性。患者被随机分配到PVI + SVC消融组或单纯PVI组。每位患者都配备了一个移动设备，用于记录每日心电图并检测房性快速心律失常。
主要终点，即导管消融术后91至365天无任何房性快速心律失常复发，两组之间无显著差异（62.9%对72%；P = 0.41）。然而，与单纯PVI组相比，PVI + SVC组表现出更高的膈神经麻痹发生率（20.8%对6%；P = 0.003）和短暂性窦房结损伤发生率（18.8%对0%；P = 0.001）。房性快速心律失常的中位数负担无显著差异（P = 0.91）。
在PVI基础上加用上腔静脉消融术在12个月时并未提高无房性快速心律失常的发生率，且导致并发症增加。这些发现不支持在阵发性或非长期持续性心房颤动患者首次导管消融的冷冻球囊手术中常规加用上腔静脉消融术。
