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70 Redefining superior vena cava isolation: integrated 3d mapping meets pulsed-field ablation-a safe and feasible approach with novel pfa catheters

heartjnl · 2025-10-14 · canonical JSON source

6 visible annotations · policy: published · automated confidence ≥ 75.00%

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Introduction Superior vena cava isolation (SVCI) may be beneficial in atrial fibrillation (AF) patients when arrhythmogenic activity from the superior vena cava (SVC) is identified, especially in the presence of suspected non-pulmonary vein (PV) triggers. Radiofrequency-based SVCI poses risks to the sinus node and phrenic nerve. Pulsed-field ablation (PFA) offers a non-thermal, tissue-selective alternative. This study aimed to assess the feasibility and safety of SVCI using novel PFA catheters with integrated 3D electroanatomical mapping.Methods Consecutive patients undergoing PFA-based pulmonary vein isolation (PVI) and SVCI were included. Two PFA catheters were used: a pentaspline catheter (FARAWAVE NAV, Boston Scientific, USA) and a variable-loop biphasic circular catheter (VARIPULSE, Johnson & Johnson, USA). SVC mapping was performed pre- and post-ablation. Exit block was confirmed by pacing from the SVC and remapping. Sinus node and phrenic nerve function were monitored intra-procedurally.Results Twenty patients were included (mean age 64.6±13 years). Persistent AF was present in 10 patients, paroxysmal AF in 7, and atypical atrial flutter in 3. Three patients (15%) had permanent pacemakers. SVC-origin ectopy was documented in 75%. Seventeen patients underwent SVCI with the pentaspline catheter, with acute isolation achieved in 94% (16/17). The median number of applications was 8 (range: 4–12). One SVCI was not completed due to transient sinus node which had recovered at the procedure’s end. No phrenic nerve injury occurred. Three patients underwent successful SVCI with the variable-loop catheter (100% acute isolation). Six applications were delivered in two patients and nine in one. Median SVCI time, including mapping, was 5 minutes. All patients remained free of AF during the first month of follow-up. No major complications were observed.Conclusions SVCI using novel PFA catheters is safe and feasible. Integrating 3D mapping allows precise, rapid ablation while minimizing risk to critical adjacent structures.