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Long-Term Outcome of Additional Superior Vena Cava to Septal Linear Ablation in Catheter Ablation of Atrial Fibrillation

Authors
 Moo‐Nyun Jin  ;  Byounghyun Lim  ;  Hee Tae Yu  ;  Tae‐Hoon Kim  ;  Jae‐Sun Uhm  ;  Boyoung Joung  ;  Moon‐Hyoung Lee  ;  Chun Hwang  ;  Hui‐Nam Pak 
Citation
 JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol.8(22) : e013985, 2019 
Journal Title
 JOURNAL OF THE AMERICAN HEART ASSOCIATION 
Issue Date
2019
Keywords
atrial fibrillation ; catheter ablation ; recurrence ; superior vena cava
Abstract
Background We previously reported the benefit of linear ablation from the superior vena cava to the right atrial septum (SVC-L) within a year after circumferential pulmonary vein isolation (CPVI) in patients with paroxysmal atrial fibrillation (AF). We explored the long-term effects of SVC-L and its potential related mechanisms. Methods and Results Among 2140 consecutive patients with AF ablation, we included 614 patients (73.3% male, aged 57.8±10.7 years, 13.7% with persistent AF) who did not undergo an extra-pulmonary vein left atrial ablation after propensity score matching; of those, 307 had additional SVC-L and 307 had CPVI alone. We evaluated the heart rate variability and computational modeling study to explore mechanisms. Although the procedure time was longer in the SVC-L group than the CPVI group (P<0.001), the complication rates did not differ (P=0.560). During 40.5±24.4 months of follow-up, the rhythm outcome was significantly better in the SVC-L group than the CPVI group (log rank, P<0.001). At 2-year follow-up of heart rate variability, a significantly higher mean heart rate (P=0.018) and a lower ratio of low/high-frequency components (P=0.011) were found with SVC-L than CPVI alone. In realistic in silico biatrial modeling, which reflected the electroanatomies of 10 patients, SVC-L significantly reduced biatrial dominant frequency compared with CPVI alone (P<0.001) and increased AF termination and defragmentation rates (P=0.033). Conclusions SVC-L ablation in addition to CPVI significantly improved the long-term rhythm outcome over 2 years after AF catheter ablation by mechanisms involving autonomic modulation and AF organization.
DOI
10.1161/JAHA.119.013985
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > BioMedical Science Institute (의생명과학부) > 1. Journal Papers
Yonsei Authors
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Lim, Byounghyun(임병현)
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
Jin, Moo Nyun(진무년) ORCID logo https://orcid.org/0000-0001-5482-4441
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/174648
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