Francesco Santoro1, Andreas Rillig2, Christian Sohns3, Alexander Pott4, Natale Daniele Brunetti5, Bruno Reissmann6, Christine Lemeš6, Tilman Maurer6, Thomas Fink7, Naotaka Hashiguchi6, Makoto Sano8, Shibu Mathew6, Tillman Dahme4, Feifan Ouyang6, Karl-Heinz Kuck6, Roland Richard Tilz8, Andreas Metzner6, Christian-Hendrik Heeger7. 1. Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy. Electronic address: dr.francesco.santoro.it@gmail.com. 2. Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany; Department of Cardiology, Charité Herzmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. 3. Department of Cardiology, Electrophysiology Bremen, Bremen, Germany; Department of Electrophysiology, Herz und Diabeteszentrum, Bad Oeynhausen, Germany. 4. Department of Internal Medicine II, University Medical Center Ulm, Ulm, Germany. 5. Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy. 6. Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. 7. Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany; Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, University Hospital Schleswig-Holstein, Luebeck, Germany. 8. Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, University Hospital Schleswig-Holstein, Luebeck, Germany.
Abstract
OBJECTIVES: This study sought to assess the acute success rate, periprocedural complications, and long-term outcomes in patients with atrial fibrillation (AF) and persistent left superior vena cava (PLSVC) treated with second-generation 28-mm cryoballoon (CB2). BACKGROUND: PLSVC is a cardiac anomaly associated with AF. METHODS: Between July 2012 and October 2018, 8 patients from 4 German high-volume centers referred for pulmonary vein isolation (PVI) demonstrated a PLSVC. PVI and ablation within the PLSVC was performed using the CB2. RESULTS: A total of 2,876 patients were treated with CB2-based PVI. Eight patients (0.28%; mean 65 ± 7 years of age, 2 paroxysmal, 6 with persistent AF, mean left atrial size of 44 ± 4 mm) presenting with PLSVC were evaluated. All patients underwent PVI, and 3 of 8 patients with documented triggered activity from PLSVC underwent PLSVC ablation with CB2. Electrical isolation of PLSVC was achieved in 2 of 3 patients. Mean procedure and fluoroscopy times were 120 ± 22 min and 32 ± 18 min, respectively. In 2 of 8 patients, major complications (right phrenic nerve palsy) occurred during right PV ablation. After 3 months, 1 of 2 patients recovered from right phrenic nerve palsy. Two patients underwent a redo procedure after AF recurrence, demonstrating PV reconnection but no triggers from PLSVC. Freedom from AF after 332 days of follow-up was 63%. CONCLUSIONS: CB2 ablation for AF in patients with PLSVC is feasible, with an increased risk for right phrenic nerve palsy. Electrical isolation of PLSVC can be achieved with the CB2 in most patients.
OBJECTIVES: This study sought to assess the acute success rate, periprocedural complications, and long-term outcomes in patients with atrial fibrillation (AF) and persistent left superior vena cava (PLSVC) treated with second-generation 28-mm cryoballoon (CB2). BACKGROUND: PLSVC is a cardiac anomaly associated with AF. METHODS: Between July 2012 and October 2018, 8 patients from 4 German high-volume centers referred for pulmonary vein isolation (PVI) demonstrated a PLSVC. PVI and ablation within the PLSVC was performed using the CB2. RESULTS: A total of 2,876 patients were treated with CB2-based PVI. Eight patients (0.28%; mean 65 ± 7 years of age, 2 paroxysmal, 6 with persistent AF, mean left atrial size of 44 ± 4 mm) presenting with PLSVC were evaluated. All patients underwent PVI, and 3 of 8 patients with documented triggered activity from PLSVC underwent PLSVC ablation with CB2. Electrical isolation of PLSVC was achieved in 2 of 3 patients. Mean procedure and fluoroscopy times were 120 ± 22 min and 32 ± 18 min, respectively. In 2 of 8 patients, major complications (right phrenic nerve palsy) occurred during right PV ablation. After 3 months, 1 of 2 patients recovered from right phrenic nerve palsy. Two patients underwent a redo procedure after AF recurrence, demonstrating PV reconnection but no triggers from PLSVC. Freedom from AF after 332 days of follow-up was 63%. CONCLUSIONS:CB2 ablation for AF in patients with PLSVC is feasible, with an increased risk for right phrenic nerve palsy. Electrical isolation of PLSVC can be achieved with the CB2 in most patients.
Authors: Julian Chun; Tilman Maurer; Andreas Rillig; Stefano Bordignon; Leon Iden; Sonia Busch; Daniel Steven; Roland R Tilz; Dong-In Shin; Heidi Estner; Felix Bourier; David Duncker; Philipp Sommer; Nils-Christian Ewertsen; Henning Jansen; Victoria Johnson; Livio Bertagnolli; Till Althoff; Andreas Metzner Journal: Herzschrittmacherther Elektrophysiol Date: 2021-11-04