The impact of empirical superior vena cava isolation in addition to pulmonary vein isolation on outcomes in atrial fibrillation – Systematic review, meta-analysis, and meta-regression

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-03-25 DOI:10.1016/j.ijcha.2025.101662

Raymond Pranata, William Kamarullah, Giky Karwiky, Chaerul Achmad, Mohammad Iqbal

{"title":"The impact of empirical superior vena cava isolation in addition to pulmonary vein isolation on outcomes in atrial fibrillation – Systematic review, meta-analysis, and meta-regression","authors":"Raymond Pranata, William Kamarullah, Giky Karwiky, Chaerul Achmad, Mohammad Iqbal","doi":"10.1016/j.ijcha.2025.101662","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Atrial tachyarrhythmia (ATa) recurrence remains high after pulmonary vein isolation (PVI), with the superior vena cava (SVC) being a common source of non-pulmonary vein foci.</div></div><div><h3>Objective</h3><div>This <em>meta</em>-analysis aimed to synthesize the latest evidence and provide elaborate comparative analysis and <em>meta</em>-regression analysis regarding the empirical SVC isolation (eSVCi) versus no eSVCi in atrial fibrillation (AF) ablation.</div></div><div><h3>Methods</h3><div>A systematic review was conducted on studies comparing eSVCi to no eSVCi (PVI-only or adjunctive SVC isolation). The primary outcome was ATa recurrence, defined as AF/atrial flutter/atrial tachycardia lasting over 30 s after a blanking period. Secondary outcomes included procedural duration, fluoroscopic duration, and complications.</div></div><div><h3>Results</h3><div>Thirteen studies involving 2,176 patients were analyzed, with a mean follow-up of 18 ± 9.6 months. ATa recurrence was significantly lower with eSVCi (OR 0.54 [95 % CI: 0.41, 0.72], p < 0.001; I<sup>2</sup> = 40.7 %). Subgroup analysis revealed eSVCi reduced ATa recurrence in observational studies but not in RCTs, and in initial ablations but not repeat procedures. eSVCi was beneficial in both PVI-only and adjunctive SVC isolation subgroups. Meta-regression showed the benefit of eSVCi was less in patients with non-paroxysmal AF (p = 0.044) and hypertension (p = 0.012). Procedural time, fluoroscopic time, and complications were similar between the two groups.</div></div><div><h3>Conclusion</h3><div>eSVCi potentially reduce ATa recurrence compared to no eSVCi, without increasing complications or prolonging procedural times.</div></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"58 ","pages":"Article 101662"},"PeriodicalIF":2.5000,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"IJC Heart and Vasculature","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S235290672500065X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Atrial tachyarrhythmia (ATa) recurrence remains high after pulmonary vein isolation (PVI), with the superior vena cava (SVC) being a common source of non-pulmonary vein foci.

Objective

This meta-analysis aimed to synthesize the latest evidence and provide elaborate comparative analysis and meta-regression analysis regarding the empirical SVC isolation (eSVCi) versus no eSVCi in atrial fibrillation (AF) ablation.

Methods

A systematic review was conducted on studies comparing eSVCi to no eSVCi (PVI-only or adjunctive SVC isolation). The primary outcome was ATa recurrence, defined as AF/atrial flutter/atrial tachycardia lasting over 30 s after a blanking period. Secondary outcomes included procedural duration, fluoroscopic duration, and complications.

Results

Thirteen studies involving 2,176 patients were analyzed, with a mean follow-up of 18 ± 9.6 months. ATa recurrence was significantly lower with eSVCi (OR 0.54 [95 % CI: 0.41, 0.72], p < 0.001; I² = 40.7 %). Subgroup analysis revealed eSVCi reduced ATa recurrence in observational studies but not in RCTs, and in initial ablations but not repeat procedures. eSVCi was beneficial in both PVI-only and adjunctive SVC isolation subgroups. Meta-regression showed the benefit of eSVCi was less in patients with non-paroxysmal AF (p = 0.044) and hypertension (p = 0.012). Procedural time, fluoroscopic time, and complications were similar between the two groups.

Conclusion

eSVCi potentially reduce ATa recurrence compared to no eSVCi, without increasing complications or prolonging procedural times.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.