title: Impact of systematic isolation of superior vena cava in addition to pulmonary vein antrum isolation on the outcome of paroxysmal, persistent, and permanent atrial fibrillation ablation: results from a randomized study.
abstract: BACKGROUND
  Pulmonary veins (PVs) have been shown to represent the most frequent sites of ectopic beats initiating paroxysmal atrial fibrillation (AF). However, additional non-PV triggers, arising from different areas, have been reported as well. One of the most common non-PV sites described is the superior vena cava.
  
  
  OBJECTIVE
  The purpose of the study was to investigate the impact resulting from the systematic isolation of the superior vena cava (SVCI) in addition to pulmonary vein antrum isolation (PVAI) on the outcome of paroxysmal, persistent, and permanent AF ablation.
  
  
  METHODS
  A total of 320 consecutive patients who had been referred to our center in order to undergo a first attempt of AF ablation were randomized into 2 groups. Group I (160 patients) underwent PVAI only; Group II (160 patients) underwent PVAI and SVCI.
  
  
  RESULTS
  AF was paroxysmal in 134 (46%), persistent in 75 (23%), and permanent in 111 (31%) of said patients. SVCI was performed on 134 of the 160 patients (84%) in Group II. SVC isolation was not performed on the remaining 26 patients either because of phrenic nerve capture or the lack of SVC potentials. Comparison of the outcome data between the 2 groups, after a follow-up of 12 months, revealed a significant difference in total procedural success solely with patients manifesting paroxysmal atrial fibrillation (56/73 [77%] Group I vs. 55/61 [90%] Group II; P = 0.04; OR 2.78).
  
  
  CONCLUSIONS
  In our study, the strategy of the empiric SVCI in addition to PVAI has improved the outcome of AF ablation solely in patients manifesting paroxysmal AF.
authors.affiliation: Cardiovascular Department, Dell'Angelo Hospital, Mestre, Venezia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Corrado
authors.forename: Aldo
authors.initials: A
authors.lastname: Bonso
authors.forename: Michela
authors.initials: M
authors.lastname: Madalosso
authors.forename: Antonio
authors.initials: A
authors.lastname: Rossillo
authors.forename: Sakis
authors.initials: S
authors.lastname: Themistoclakis
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.forename: Antonio
authors.initials: A
authors.lastname: Raviele
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000601:surgery*