A novel approach for effective superior vena cava isolation using the CARTO electroanatomical mapping system

Abstract

Abstract Background Previous studies have demonstrated that some patients have spontaneous right atrium (RA)‐superior vena cava (SVC) conduction block, which could be utilized to isolate the SVC effectively by using the Rhythmia mapping system (Boston Scientific). However, employing this approach for SVC isolation using the CARTO electroanatomical mapping system (Biosense Webster) has not yet been clarified. This study aimed to evaluate the safety and efficacy of SVC isolation using the extended early meets late (EEML) tool with the CARTO system. Methods The patients who underwent SVC isolation using the CARTO system were enrolled in this study. The RA‐SVC conduction block was visualized with an EEML tool. We prospectively assessed the safety and efficacy of SVC isolation using this system. Results We analyzed 54 patients, and all SVCs were successfully isolated with no complications. Altogether, 44 patients (81.5%) had spontaneous RA‐SVC conduction block, and the remaining 10 patients (18.5%) did not. The block group required fewer radiofrequency deliveries for the SVC isolation than the nonblock group (10.7 ± 5.0 vs 15.5 ± 4.8, P = .009). The size of the isolated area in the block group was larger than that in the nonblock group (15.2 ± 5.1 cm2 vs 12.4 ± 2.5 cm2, P = .017). Conclusions Approximately 80% of the patients in this study developed a spontaneous RA‐SVC conduction block, which might contribute to shortening the time of ablation and avoiding complications.

Keywords

• atrial fibrillation
• CARTO system
• extended early meets late
• lower threshold
• superior vena cava isolation