Skip to main content
SpringerLink
Log in

Influence of power setting on superior vena cava potential during right pulmonary vein isolation

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

High-power short-duration (HP-SD) ablation could reduce collateral tissue damage by shortening the conductive heating phase. However, it is difficult to evaluate the transmural effect of ablation lesions during pulmonary vein isolation (PVI) procedures. The present study aimed to evaluate the change in superior vena cava (SVC) potential delay as a surrogate marker of collateral tissue damage during right PVI, which is adjacent to SVC.

Methods

Out of 250 consecutive patients who underwent PVI, 86 patients in whom SVC potential during sinus rhythm was recorded both before and after right PVI were analyzed. In 46 of the patients, an HP-SD setting of 45–50 W was used (HP-SD group). In the remaining 40 patients, a conventional power setting of 20–30 W was used (conventional group). We compared the change in SVC potential delay after right PVI, radiofrequency energy, and mean contact force in the anterior–superior right PVI line, which was close to the posterior aspect of SVC, between the two groups.

Results

Although the total delivered radiofrequency energy (2,924 J vs. 2,604 J) and the mean contact force (18.5 g vs. 16.0 g) in the SVC overlapping area did not differ, the change in SVC potential delay after right PVI was significantly longer in the conventional group compared to the HP-SD group (5.0 ms vs. 0.0 ms, p < 0.001).

Conclusions

The changes in SVC potential delay after right PVI might be a surrogate marker of collateral tissue damage according to the used energy settings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Lloyd-Jones DM, Wang TJ, Leip EP, et al. Lifetime risk for development of atrial fibrillation: the Framingham heart study. Circulation. 2004;110:1042–6.

    Article  Google Scholar 

  2. Benjamin EJ, Wolf PA, D’Agostino RB, et al. Impact of atrial fibrillation on the risk of death: the Framingham heart study. Circulation. 1998;98:946–52.

    Article  CAS  Google Scholar 

  3. Machino-Ohtsuka T, Seo Y, Ishizu T, et al. Relationships between maintenance of sinus rhythm and clinical outcomes in patients with heart failure with preserved ejection fraction and atrial fibrillation. J Cardiol. 2019;74:235–44.

    Article  Google Scholar 

  4. Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace. 2012;14:528–606.

    Article  Google Scholar 

  5. Wilber DJ, Pappone C, Neuzil P, et al. ThermoCool AF Trial Investigators. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010;303:333–40.

    Article  CAS  Google Scholar 

  6. Kautzner J, Neuzil P, Lambert H, et al. EFFICAS II: optimization of catheter contact force improves outcome of pulmonary vein isolation for paroxysmal atrial fibrillation. Europace. 2015;17:1229–35.

    Article  Google Scholar 

  7. Chikata A, Kato T, Sakagami S, et al. Optimal force-time integral for pulmonary vein isolation according to anatomical wall thickness under the ablation line. J Am Heart Assoc. 2016;5:e003155.

    Article  Google Scholar 

  8. Castrejón-Castrejón S, Martínez Cossiani M, Ortega Molina M, et al. Feasibility and safety of pulmonary vein isolation by high-power short-duration radiofrequency application: short-term results of the POWER-FAST PILOT study. J Interv Card Electrophysiol. 2020;57:57–65.

    Article  Google Scholar 

  9. Winkle RA, Mohanty S, Patrawala RA, et al. Low complication rates using high power (45–50 W) for short duration for atrial fibrillation ablations. Heart Rhythm. 2019;16:165–9.

    Article  Google Scholar 

  10. Kaneshiro T, Kamioka M, Hijioka N, et al. Characteristics of esophageal injury in ablation of atrial fibrillation using a high-power short-duration setting. Circ Arrhythm Electrophysiol. 2020;13:e008602.

    Article  CAS  Google Scholar 

  11. Das M, Loveday JJ, Wynn GJ, et al. Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values. Europace. 2017;19:775–83.

    PubMed  Google Scholar 

  12. Hussein A, Das M, Chaturvedi V, et al. Prospective use of ablation index targets improves clinical outcomes following ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2017;28:1037–47.

    Article  Google Scholar 

  13. Kamioka M, Hijioka N, Matsumoto Y, et al. Uncontrolled blood pressure affects atrial remodeling and adverse clinical outcome in paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2018;41:402–10.

    Article  Google Scholar 

  14. Kholová I, Kautzner J. Morphology of atrial myocardial extensions into human caval veins: a postmortem study in patients with and without atrial fibrillation. Circulation. 2004;110:483–8.

    Article  Google Scholar 

  15. Anjo N, Nakahara S, Okumura Y, et al. Impact of catheter tip-tissue contact on three-dimensional left atrial geometries: relationship between the external structures and anatomic distortion of 3D fast anatomical mapping and high contact force guided images. Int J Cardiol. 2016;222:202–8.

    Article  Google Scholar 

  16. Kimura T, Fukumoto K, Nishiyama N, et al. Inadvertent electrical superior vena cava isolation during right pulmonary vein isolation. Heart Rhythm. 2012;9:1177–8.

    Article  Google Scholar 

  17. Yagishita A, Yamauchi Y, Hirao K. Superior vena cava isolation by right pulmonary vein ablation. Europace. 2014;16:346.

    Article  Google Scholar 

  18. Yamasaki H, Adachi T, Komatsu Y, et al. Unexpected electrical isolation of the superior vena cava during radiofrequency hot balloon ablation in the right superior pulmonary vein. Circ J. 2017;81:763–5.

    Article  Google Scholar 

  19. Tanaka Y, Takahashi A, Takagi T, et al. Novel ablation strategy for isolating the superior vena cava using ultra high-resolution mapping. Circ J. 2018;82:2007–15.

    Article  Google Scholar 

  20. Ichihara N, Miyazaki S, Kuroi A, et al. Impact of pulmonary vein isolation on superior vena cava potentials with a second-generation cryoballoon. J Cardiovasc Electrophysiol. 2015;26:1321–6.

    Article  Google Scholar 

  21. Kenigsberg DN, Martin N, Lim HW, et al. Quantification of the cryoablation zone demarcated by pre and postprocedural electroanatomic mapping in atrial fibrillation patients using the 28-mm second-generation cryoballoon. Heart Rhythm. 2015;12:283–90.

    Article  Google Scholar 

  22. Bhaskaran A, Chik W, Pouliopoulos J, et al. Five seconds of 50–60 W radio frequency atrial ablations were transmural and safe: an in vitro mechanistic assessment and force-controlled in vivo validation. Europace. 2017;19:874–80.

    PubMed  Google Scholar 

  23. Pappone C, Oral H, Santinelli V, et al. Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation. Circulation. 2004;109:2724–6.

    Article  Google Scholar 

  24. Dagres N, Kottkamp H, Piorkowski C, et al. Rapid detection and successful treatment of esophageal perforation after radiofrequency ablation of atrial fibrillation: lessons from five cases. J Cardiovasc Electrophysiol. 2006;17:1213–5.

    Article  Google Scholar 

  25. Coulombe N, Paulin J, Su W. Improved in vivo performance of second-generation cryoballoon for pulmonary vein isolation. J Cardiovasc Electrophysiol. 2013;24:919–25.

    Article  Google Scholar 

  26. Yong Ji S, Dewire J, Barcelon B, et al. Phrenic nerve injury: an underrecognized and potentially preventable complication of pulmonary vein isolation using a wide-area circumferential ablation approach. J Cardiovasc Electrophysiol. 2013;24:1086–91.

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Naoko Hijioka and Takashi Kaneshiro are co-first authors and equally contributed to this work.

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan

    Naoko Hijioka, Takashi Kaneshiro, Takeshi Nehashi, Kazuaki Amami, Minoru Nodera, Shinya Yamada, Tetsuro Yokokawa, Tomofumi Misaka & Yasuchika Takeishi

  2. Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan

    Takashi Kaneshiro & Yasuchika Takeishi

Authors
  1. Naoko Hijioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takashi Kaneshiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takeshi Nehashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kazuaki Amami
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Minoru Nodera
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shinya Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tetsuro Yokokawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tomofumi Misaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yasuchika Takeishi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Naoko Hijioka, M.D.: concept/design, data analysis/interpretation, drafting article, statics, data collection.

Takashi Kaneshiro, M.D.: concept/design, data analysis/interpretation, drafting article, statics, data collection.

Takeshi Nehashi, M.D.: approval of article, data collection.

Kazuaki Amami, M.D.: approval of article, data collection.

Minoru Nodera, M.D.: approval of article, data collection.

Shinya Yamada, M.D.: approval of article, data collection.

Tetsuro Yokokawa, M.D.: approval of article, data collection.

Tomofumi Misaka, M.D.: approval of article, data collection.

Yasuchika Takeishi, M.D.: critical revision of article, approval of article, data collection.

Corresponding author

Correspondence to Takashi Kaneshiro.

Ethics declarations

Disclosures

Takashi Kaneshiro belongs to the Department of Arrhythmia and Cardiac Pacing, which is supported by Abbott Medical Japan LLC, Biotronik Japan Inc., and Nihon Kohden Corp. These companies are not associated with the contents of this study.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hijioka, N., Kaneshiro, T., Nehashi, T. et al. Influence of power setting on superior vena cava potential during right pulmonary vein isolation. J Interv Card Electrophysiol 65, 25–31 (2022). https://doi.org/10.1007/s10840-021-01058-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-021-01058-z

Keywords

Search

Navigation