Impact of Persistent Left Superior Vena Cava on Outcomes With Atrial Fibrillation Ablation.

Background: A persistent left superior vena cava (PLSVC) can be a trigger for atrial fibrillation (AF).

Objective: We aimed to compare post-ablation 1-year freedom from recurrent atrial tachycardia (AT)/AF in PLSVC patients with a matched population without PLSVC (n-PLSVC).

Methods: A single-center, retrospective, case-control study between 2008 and 2022. Pre-ablation imaging identified patients with PLSVC. Propensity score matching for age, sex, BMI, type of AF, AF ablation energy type, left atrial volume, and year of ablation was performed to identify five controls for each PLSVC patient. We excluded patients who had less than 1 year of follow-up post-ablation or underwent prior surgical ablation.

Results: There were 90 total patients including 15 PLSVC patients and 75 matched controls (60 ± 10 years old, 31% women, 58% paroxysmal, 62% radiofrequency). One-year freedom from AF was lower with PLSVC (27%) than n-PLSVC (59%, p = 0.02). The PLSVC was targeted for ablation in 5/15 patients (33%), all of whom had recurrent AT/AF within 1 year. Redo AF ablations were performed in 40% (6/15) of PLSVC patients. Freedom from AF at last follow-up (median 2.1, IQR 0.5-4.0 years) was 83% in PLSVC patients who underwent redo ablation. The only complication was right atrial lead dysfunction post-ablation requiring lead revision.

Conclusion: Although the post-ablation freedom from AF is lower in patients with PLSVC than n-PLSVC, repeat ablation can result in a high freedom from AF in patients with PLSVC. Further study is necessary to determine the optimal methods and role for PLSVC ablation (including the role for pulse-field ablation).