Results of ICE-Guided Isolation of the Superior Vena Cava With Pulsed Field Ablation

Nicola Pierucci; Vincenzo Mirco La Fazia; Sanghamitra Mohanty; Marco Schiavone; Brandon Doty; Kirollos Gabrah; Domenico G Della Rocca; J David Burkhardt; Amin Al-Ahmad; Luigi Di Biase; Michela Casella; Antonio Dello Russo; Devi Nair; Moussa Mansour; Claudio Tondo; Andrea Natale

doi:10.1016/j.jacep.2024.11.009

Results of ICE-Guided Isolation of the Superior Vena Cava With Pulsed Field Ablation

JACC Clin Electrophysiol. 2025 Jan 15:S2405-500X(24)01000-4. doi: 10.1016/j.jacep.2024.11.009. Online ahead of print.

Authors

Nicola Pierucci¹, Vincenzo Mirco La Fazia², Sanghamitra Mohanty², Marco Schiavone³, Brandon Doty⁴, Kirollos Gabrah⁴, Domenico G Della Rocca⁵, J David Burkhardt², Amin Al-Ahmad², Luigi Di Biase⁶, Michela Casella⁷, Antonio Dello Russo⁷, Devi Nair⁴, Moussa Mansour⁸, Claudio Tondo⁹, Andrea Natale¹⁰

Affiliations

¹ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy.
² Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
³ Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
⁴ St. Bernard's Medical Center, Jonesboro, Arkansas, USA.
⁵ Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
⁶ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Electrophysiology, Albert Einstein College of Medicine, New York, New York, USA.
⁷ Marche Polytechnic University, Ancona, Italy; University Hospital "Azienda Ospedaliero-Universitaria delle Marche," Ancona, Italy.
⁸ Massachusetts General Hospital, Boston, Massachusetts, USA.
⁹ Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
¹⁰ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA; Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy. Electronic address: [email protected].

PMID: 39846925
DOI: 10.1016/j.jacep.2024.11.009

Abstract

Background: Earlier studies have documented the risk for sinoatrial node injury and phrenic nerve paralysis as complications following radiofrequency catheter ablation for electrical isolation of the superior vena cava (SVCI).

Objectives: The aim of this study was to assess the safety and feasibility of SVCI in patients with atrial fibrillation undergoing pulsed field ablation (PFA) METHODS: Six hundred sixteen consecutive patients undergoing PFA for pulmonary vein isolation plus SVCI were included in this multicenter analysis. Superior vena cava (SVC) ablation was performed under the continuous guidance of intracardiac echocardiography. The PFA catheter was placed at the junction between the SVC and the right atrium at the level of the lower border of the pulmonary artery. A total of 4 applications were given to achieve complete electrical isolation of the SVC. Sinus node injury and phrenic nerve stunning were checked during the procedure, before discharge, and at 2-month follow-up.

Results: A total of 616 patients receiving SVCI were included in the analysis. Acute SVCI was achieved in all 616 patients (100%). In the flower configuration used in the first 10 patients, 2 transient sinus node injuries and 2 episodes of phrenic nerve stunning were observed, which resolved spontaneously during the procedure. In the remaining patients, the basket configuration was used; only 1 episode of phrenic nerve stunning was registered, which regressed before the end of the procedure. No permanent damages were registered at discharge and at 2-month follow-up.

Conclusions: Intracardiac echocardiography-guided PFA can effectively isolate the SVC with a good safety profile.

Keywords: atrial fibrillation; intracardiac echocardiography; phrenic nerve paralysis; pulsed field ablation; sinus node stunning; superior vena cava isolation.