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Predictors of ectopic firing from the superior vena cava in patients with paroxysmal atrial fibrillation

  • Keiichi InadaEmail author
  • Seiichiro Matsuo
  • Ken-ichi Tokutake
  • Ken-ichi Yokoyama
  • Mika Hioki
  • Ryohsuke Narui
  • Keiichi Ito
  • Shin-ichi Tanigawa
  • Seigo Yamashita
  • Michifumi Tokuda
  • Kenri Shibayama
  • Satoru Miyanaga
  • Ken-ichi Sugimoto
  • Michihiro Yoshimura
  • Teiichi Yamane
Article

Abstract

Purpose

Although catheter ablation targeting the pulmonary vein (PV) is a well-known therapy for patients with paroxysmal atrial fibrillation (PAF), ectopic firings from the superior vena cava (SVC) can initiate PAF. The purpose of this study was to investigate predictors of SVC firing.

Methods

The subjects included 336 consecutive PAF patients (278 males, age 56.1 ± 10.8 years) undergoing atrial fibrillation (AF) ablation. The appearance of SVC firing was monitored throughout the procedure using a decapolar catheter with multiple electrodes to record electrograms of the coronary sinus and SVC. In addition to PV isolation, SVC isolation was performed only in patients with documented SVC firing.

Results

SVC firing was observed in 43/336 (12.8 %) of the patients, among whom complete isolation of the SVC was achieved in 40/43 (93 %) patients. A lower body mass index (BMI) (22.8 ± 2.8 vs 24.1 ± 3.1 kg/m2, p = 0.007) and higher prevalence of prior ablation procedures (58 vs 18 %, p = 0.0001) were related to the presence of SVC firing. In a multivariate analysis, a lower BMI (p = 0.012; odds ratio 0.83, 95 % CI 0.72 to 0.96) and history of prior ablation procedures (p < 0.0001; odds ratio 5.37, 95 % CI 2.71 to 10.63) were found to be independent predictors of the occurrence of SVC firing. Among 96 patients undergoing repeat ablation procedures, less PV-left atrial re-conduction was observed in patients with SVC firing than in those without (2.7 ± 1.2 vs 3.2 ± 0.8, p = 0.02).

Conclusions

The presence of SVC firing in patients with PAF is associated with a history of repeat ablation procedures and lower BMI values.

Keywords

Atrial fibrillation Catheter ablation Superior vena cava Predictor Ectopic firing 

Notes

Acknowledgments

We are grateful to Brain Quinn (Editor-in-Chief, Japan Medical Communication) for providing linguistic comments on the manuscript.

Conflict of interest

None of the authors has any relevant conflicts.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Keiichi Inada
    • 1
    Email author
  • Seiichiro Matsuo
    • 1
  • Ken-ichi Tokutake
    • 1
  • Ken-ichi Yokoyama
    • 1
  • Mika Hioki
    • 1
  • Ryohsuke Narui
    • 1
  • Keiichi Ito
    • 1
  • Shin-ichi Tanigawa
    • 1
  • Seigo Yamashita
    • 1
  • Michifumi Tokuda
    • 1
  • Kenri Shibayama
    • 1
  • Satoru Miyanaga
    • 1
  • Ken-ichi Sugimoto
    • 1
  • Michihiro Yoshimura
    • 1
  • Teiichi Yamane
    • 1
  1. 1.Department of CardiologyThe Jikei University School of MedicineTokyoJapan

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