Evaluation of superior vena cava stenosis after superior vena cava
isolation in patients with atrial fibrillation.
Abstract
Introduction: The isolation of superior vena cava (SVCI) and pulmonary
vein isolation (PVI) improve the success rate of atrial fibrillation
(AF) ablation. Limited information is available on the quantitative
assessment of the narrowing of SVC after ablation. Methods: Ninety-one
AF patients with SVC potentials were enrolled in this study. After PVI,
SVCI was performed circumferentially at the level of the lower border of
the right pulmonary artery. Radiofrequency (RF) pulses were delivered on
a point-by-point basis for 30s at each point with an irrigated catheter
in a temperature-controlled mode with the maximum temperature set at 42℃
and the maximum power at 25W. Follow up contrast-enhanced computed
tomography was performed at four months after the ablation procedure.
SVC narrowing was followed up in time (mean ± standard deviation = 20 ±
4.2 months). Results: All SVCIs were successfully achieved without
severe complications. The pre-ablation SVC dimension at the level of the
isolation line was 2.50 ± 0.94 cm2, and the post-ablation SVC dimension
was 2.19 ± 0.82 cm2 (p = 0.016). Severe stenosis (reductions of SVC
dimension > 75%) was not observed in this study. Moreover,
the relationship between the SVC narrowing and the RF application time
was not significant in this study. In the eight SVC cases with SVC
narrowing, the mean SVC area recovered as a function time from 1.56 ±
0.42 cm2 to 1.80 ± 0.57cm2. Conclusion: The SVCI caused minor reductions
in the SVC dimensions, but did not cause severe stenosis with
life-threatening symptoms.