Abstract 4141913: Feasibility and safety of ICE-guided electrical isolation of the superior vena cava using pulsed-field ablation in patients with atrial fibrillation

Background: Earlier studies have documented the risk of sinoatrial node injury and phrenic nerve palsy as complications following radiofrequency catheter ablation for electrical isolation of superior vena cava (SVCI). Objective: We evaluated the safety and feasibility of SVCI in patients with atrial fibrillation (AF) undergoing pulsed-field ablation (PFA) Methods: Consecutive patients undergoing PFA procedure for SVCI were included in this multicenter analysis. SVC ablation was performed with the ablation catheter placed at the level of the pulmonary artery under the guidance of intracardiac echocardiography (ICE). A total of 4 applications were given; two in the flower and 2 in the basket configuration of the PFA catheter. In all patients, the procedure was performed under imaging with ICE; endpoint was complete electrical isolation of the vein. Mapping was done before and after ablation to verify the effect of PFA. Patients were asked to report symptoms compatible with phrenic nerve injury (cough, shortness of breath) at follow-up. They also underwent periodic clinical and 7-day holter monitoring to assess sinus node injury. Results: A total of 67 patients (age: 62.92±9.44 year, male: 20 (66.6%), BMI: 26.43±4.33) receiving SVCI were included in the analysis. Acute SVCI was achieved in all 67 (100%) patients (fig 1 and 2). After ablation, the PFA catheter placed in the SVC did not record any electrical activity (figure 2). No phrenic nerve palsy (normal diaphragmatic motion with fluoroscopy) or sinus node injury (no acceleration of the sinus rate) was observed during the procedure. Additionally, during the 3-month follow-up period, patients neither reported symptoms pertaining to phrenic nerve injury nor the Holter monitoring revealed sinus node dysfunction. Conclusion: ICE-guided PFA can effectively isolate SVC without causing phrenic nerve palsy or sinus node injury.