Pierucci Nicola, La Fazia Vincenzo Mirco, Mohanty Sanghamitra, Schiavone Marco, Doty Brandon, Gabrah Kirollos, Della Rocca Domenico G, Burkhardt J David, Al-Ahmad Amin, Di Biase Luigi, Casella Michela, Russo Antonio Dello, Nair Devi, Mansour Moussa, Tondo Claudio, Natale Andrea
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy.
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
JACC Clin Electrophysiol. 2025 Apr;11(4):752-760. doi: 10.1016/j.jacep.2024.11.009. Epub 2025 Jan 22.
Earlier studies have documented the risk for sinoatrial node injury and phrenic nerve paralysis as complications following radiofrequency catheter ablation for electrical isolation of the superior vena cava (SVCI).
The aim of this study was to assess the safety and feasibility of SVCI in patients with atrial fibrillation undergoing pulsed field ablation (PFA) METHODS: A total of 1,600 consecutive patients undergoing PFA for pulmonary vein isolation plus SVCI were included in this multicenter analysis. Superior vena cava (SVC) ablation was performed under the continuous guidance of intracardiac echocardiography. The PFA catheter was placed at the junction between the SVC and the right atrium at the level of the lower border of the pulmonary artery. A total of 4 applications were given to achieve complete electrical isolation of the SVC. Sinus node injury and phrenic nerve stunning were checked during the procedure, before discharge, and at 2-month follow-up.
A total of 616 patients receiving SVCI were included in the analysis. Acute SVCI was achieved in all 616 patients (100%). In the flower configuration used in the first 10 patients, 2 transient sinus node injuries and 2 episodes of phrenic nerve stunning were observed, which resolved spontaneously during the procedure. In the remaining patients, the basket configuration was used; only 1 episode of phrenic nerve stunning was registered, which regressed before the end of the procedure. No permanent damages were registered at discharge and at 2-month follow-up.
Intracardiac echocardiography-guided PFA can effectively isolate the SVC with a good safety profile.
早期研究已记录到，在进行上腔静脉电隔离（SVCI）的射频导管消融术后，存在窦房结损伤和膈神经麻痹的风险。
本研究旨在评估脉冲场消融（PFA）治疗心房颤动患者时进行SVCI的安全性和可行性。
本多中心分析纳入了1600例连续接受PFA进行肺静脉隔离加SVCI的患者。在心脏超声心动图的持续引导下进行上腔静脉（SVC）消融。将PFA导管置于肺动脉下缘水平的SVC与右心房交界处。共进行4次消融以实现SVC的完全电隔离。在手术过程中、出院前和2个月随访时检查窦房结损伤和膈神经麻痹情况。
共有616例接受SVCI的患者纳入分析。所有616例患者（100%）均实现了急性SVCI。在前10例患者使用的花型配置中，观察到2例短暂性窦房结损伤和2次膈神经麻痹发作，均在手术过程中自行缓解。在其余患者中，使用了篮型配置；仅记录到1次膈神经麻痹发作，在手术结束前恢复。出院时和2个月随访时均未发现永久性损伤。
心脏超声心动图引导下的PFA能够有效隔离SVC，安全性良好。
