Feasibility of superior vena cava isolation in patients with cardiac
implantable electronic devices
Abstract
Introduction: Some patients with cardiac implantable electronic devices
(CIEDs) require atrial fibrillation (AF) ablation, and the superior vena
cava (SVC) has been identified as one of the most common non-pulmonary
vein foci of AF. This study aimed to investigate the interaction between
SVC isolation (SVCI) and CIED leads implanted through the SVC. Methods
and Results: We studied 34 patients with CIEDs who had undergone SVCI as
part of AF ablation (CIED group), involving a total of 71 CIED leads. A
similar number of age-, sex-, and AF type-matched patients without CIEDs
formed a control group (non-CIED group). Patients’ background and
procedural characteristics were compared between the groups. In the CIED
group, lead parameters before and after AF ablation were compared, and
lead failure after AF ablation was also examined in detail. Procedural
characteristics other than fluoroscopic time were similar in both
groups. The success rate of SVCI after the final ablation procedure was
91.2% in the CIED group and 100% in the non-CIED group; however, these
differences were not statistically significant. Lead parameters before
and after the AF ablation did not significantly differ between the 2
groups. Lead failure was observed in 3 patients, with a sensing noise in
1 patient and an impedance increase in 2 patients after SVCI.
Conclusions: SVCI was achievable without lead failure and significant
change in lead parameters in most patients with CIEDs; however, the
8.8% incidence of lead failure observed after SVCI should be noted.