Author + information
- Received December 10, 2018
- Revision received February 18, 2019
- Accepted February 19, 2019
- Published online March 27, 2019.
- Francesco Santoro, MDa,b,∗ (, )
- Andreas Rillig, MDa,c,
- Christian Sohns, MDd,e,
- Alexander Pott, MDf,
- Natale Daniele Brunetti, MD, PhDb,
- Bruno Reissmann, MDa,
- Christine Lemeš, MDa,
- Tilman Maurer, MDa,
- Thomas Fink, MDa,g,
- Naotaka Hashiguchi, MDa,
- Makoto Sano, MDg,
- Shibu Mathew, MDa,
- Tillman Dahme, MDf,
- Feifan Ouyang, MDa,
- Karl-Heinz Kuck, MDa,
- Roland Richard Tilz, MDg,
- Andreas Metzner, MDa and
- Christian-Hendrik Heeger, MDa,g
- aDepartment of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- bDepartment of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- cDepartment of Cardiology, Charité Herzmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
- dDepartment of Cardiology, Electrophysiology Bremen, Bremen, Germany
- eDepartment of Electrophysiology, Herz und Diabeteszentrum, Bad Oeynhausen, Germany
- fDepartment of Internal Medicine II, University Medical Center Ulm, Ulm, Germany
- gDepartment of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, University Hospital Schleswig-Holstein, Luebeck, Germany
- ↵∗Address for correspondence:
Dr. Francesco Santoro, Department of Cardiology, Asklepios Klinik–St. Georg, Lohmühlenstrasse 5, 20099 Hamburg, Germany.
Objectives This study sought to assess the acute success rate, periprocedural complications, and long-term outcomes in patients with atrial fibrillation (AF) and persistent left superior vena cava (PLSVC) treated with second-generation 28-mm cryoballoon (CB2).
Background PLSVC is a cardiac anomaly associated with AF.
Methods Between July 2012 and October 2018, 8 patients from 4 German high-volume centers referred for pulmonary vein isolation (PVI) demonstrated a PLSVC. PVI and ablation within the PLSVC was performed using the CB2.
Results A total of 2,876 patients were treated with CB2-based PVI. Eight patients (0.28%; mean 65 ± 7 years of age, 2 paroxysmal, 6 with persistent AF, mean left atrial size of 44 ± 4 mm) presenting with PLSVC were evaluated. All patients underwent PVI, and 3 of 8 patients with documented triggered activity from PLSVC underwent PLSVC ablation with CB2. Electrical isolation of PLSVC was achieved in 2 of 3 patients. Mean procedure and fluoroscopy times were 120 ± 22 and 32 ± 18 min, respectively. In 2 of 8 patients, major complications (right phrenic nerve palsy) occurred during right PV ablation. After 3 months, 1 of 2 patients recovered from right phrenic nerve palsy. Two patients underwent a redo procedure after AF recurrence, demonstrating PV reconnection but no triggers from PLSVC. Freedom from AF after 332 days of follow-up was 63%.
Conclusions CB2 ablation for AF in patients with PLSVC is feasible, with an increased risk for right phrenic nerve palsy. Electrical isolation of PLSVC can be achieved with the CB2 in most patients.
- atrial fibrillation
- coronary sinus
- left atrium
- persistent(s) left superior vena cava
- phrenic nerve palsy
- pulmonary veins
Dr. Rillig has received travel grants and speaker honoraria from Medtronic. Dr. Dahme has received speakers’ fees and consulting fees from Medtronic. Dr. Kuck is a consultant for Medtronic, Boston Scientific, and Biosense Webster. Dr. Tilz has received research grants from Medtronic and Biotronik; and has received travel grants from Cardiofocus; has relationships with Biosense Webster, Medtronic, Abbot, Sentrheart, and Daiichi Sankyo; and has received speakers’ bureau honoraria from Biosense Webster, Medtronic, Abbot, Sentrheart, and Daiichi Sankyo. Dr. Metzher has received speakers’ bureau honoraria and travel grants from Medtronic. Dr. Heeger has received travel grants from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received December 10, 2018.
- Revision received February 18, 2019.
- Accepted February 19, 2019.
- 2019 American College of Cardiology Foundation
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