Abstract 13447: Superior Vena Cava Isolation From the Right Atrial Posterior Wall: A Case Series

Abstract

Introduction: Superior vena cava (SVC) isolation is a common ablation strategy to address non-pulmonary vein triggers in patients with paroxysmal and non-paroxysmal AF. SVC isolation with circumferential ablation might be difficult to achieve because of the phrenic nerve (PN) location in its anterolateral aspect. Hypothesis: It is possible to isolate the SVC sparing its anterolateral aspect given the presence of preferential conduction from the posterior wall of the right atrium (RA) to the SVC. Methods: Consecutive patients in which SVC isolation ablating in the RA posterior wall. RF ablation was started in the septal aspect of the SVC-RA junction and it was continued posteriorly-inferiorly in sites of early activation (relative to the SVC) until electrical isolation was obtained. The distance between the SVC-RA junction and the site of SVC isolation was measured with 3D electro-anatomical mapping. Results: 85 patients were included in the analysis. 27% were females, with a mean age of 66 ± 10 years, 21% had paroxysmal AF, 42% persistent AF, 36% longstanding persistent AF. The procedure was a repeat ablation in 58% of the cases, with a mean procedure time of 124 ± 38 minutes. Acute SVC isolation was achieved in 98%. Mean distance of isolation from the SVC-RA junction was 19.9 ± 5.1 mm (range 10.2-32.1 mm). At follow-up, we observed 2 (2%) transient PN injuries. After this, we began performing PN mapping in the PW, which precluded complete SVC isolation in 1 case (see Figure 2). Conclusions: SVC isolation can be achieved without circumferential ablation by targeting sites with early activation (relative to the SVC) in the RA posterior wall.