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Safety and feasibility of electrical isolation of the superior vena cava in addition to pulmonary vein ablation for paroxysmal atrial fibrillation using the cryoballoon: lessons from a prospective study

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Abstract

Purpose

The purpose of this study was to evaluate the feasibility and safety of superior vena cava (SVC) isolation in addition to standard pulmonary vein isolation (PVI) using the second-generation cryoballoon (CB) in patients with paroxysmal atrial fibrillation.

Methods

Thirty-seven consecutive patients that underwent CB ablation for paroxysmal atrial fibrillation (PAF) were prospectively enrolled in our study. After PVI the SVC was mapped for potentials. If the SVC exhibited electrical activity, isolation was achieved performing a single 180-s balloon application.

Results

Regarding SVC isolation, 180-s freeze in the SVC could be completed in 32 (86.4%) patients, and 5 patients had at least 120 s of freezing application (13.5%). Real-time recording during SVC isolation was observed in 30 (81.0%) patients. The mean time to isolation was 36.9 ± 28.7 s and the temperature at isolation was − 33 (− 15 to − 40) °C. No cases developed persistent phrenic nerve palsy (PNP) or any other complication.

Conclusions

Superior vena cava isolation proved to be safe and feasible with the second generation cryoballoon in a prospective series of patients affected by PAF.

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Abbreviations

CMAPs:

Compound motor action potentials

CI:

Confidence interval

CB:

Cryoballoon

ISNT:

Inappropriate sinus node tachycardia

LA:

Left atrium

PAF:

Paroxysmal atrial fibrillation

PN:

Phrenic nerve

PNP:

Phrenic nerve palsy

PVI:

Pulmonary vein isolation

RF:

Radiofrequency

SVC:

Superior vena cava

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Author notes

  1. Saverio Iacopino and Thiago Guimarães Osorio have contributed equally to the manuscript as first authors.

    Carlo de Asmundis and Gian-Battista Chierchia have contributed equally as senior authors.

Authors and Affiliations

  1. Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, RA, Italy

    Saverio Iacopino, Pasquale Filannino & Paolo Artale

  2. Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, Brussels, Belgium

    Thiago Guimarães Osório, Juan Sieira, Erwin Ströker, Gezim Bala, Ingrid Overeinder, Ebru Hacioglu, Paul-Adrian Călburean, Gaetano Paparella, Pedro Brugada, Carlo de Asmundis & Gian-Battista Chierchia

Authors
  1. Saverio Iacopino
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  2. Thiago Guimarães Osório
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  14. Gian-Battista Chierchia
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Corresponding author

Correspondence to Gian-Battista Chierchia.

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The study was approved by the ethical committee of Maria Cecilia Hospital, Cotignola. The protocol was carried out in accordance with the ethical principles for medical research involving human subjects established by the Declaration of Helsinki, protecting the privacy of all participants as well as the confidentiality of their personal information.

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Iacopino, S., Osório, T.G., Filannino, P. et al. Safety and feasibility of electrical isolation of the superior vena cava in addition to pulmonary vein ablation for paroxysmal atrial fibrillation using the cryoballoon: lessons from a prospective study. J Interv Card Electrophysiol 60, 255–260 (2021). https://doi.org/10.1007/s10840-020-00740-y

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