Role of electroanatomical mapping guided superior vena cava isolation in paroxysmal atrial fibrillation patients without provoked superior vena cava trigger: A randomized controlled study

Abstract Aims Data about whether empirical superior vena cava isolation (SVCI) improves the success rate of paroxysmal atrial fibrillation (PAF) is conflicting. This study sought to firstly investigate the characteristics of SVC-triggered AF, and secondly investigate the impact of electroanatomical mapping guided SVCI in addition to circumferential pulmonary vein isolation (CPVI) on the outcome of PAF ablation in the absence of provoked SVC triggers. Methods A total of 130 patients undergoing PAF ablation underwent electrophysiological studies before ablation. In patients whom SVC triggers were identified, SVCI was performed in addition to CPVI. Patients without provoked SVC triggers were randomized in a 1:1 ratio to CPVI plus SVCI or CPVI only. The primary endpoint was freedom from any documented atrial tachyarrhythmias lasting over 30 seconds after a 3-month blanking period without anti-arrhythmic drugs at 12 months after ablation. Results SVC triggers were identified in 30 (23.1%) patients with PAF. At 12 months, 93.3% of those with provoked SVC triggers whom underwent CPVI plus SVCI were free from atrial tachyarrhythmias. In patients without provoked SVC triggers, SVCI in addition to CPVI did not increase freedom from atrial tachyarrhythmias (87.9% vs. 79.6%, log-rank p = 0.28). Conclusions Electroanatomical mapping guided SVCI in addition to CPVI did not increase the success rate of PAF ablation in patients who have no identifiable SVC triggers.