Persistence of Low‐Voltage Area in the Superior Vena Cava Following Pulsed‐Field Ablation for Pulmonary Vein Isolation: Findings During Repeat Procedure

INTRODUCTION: Superior vena cava (SVC) conduction delay or isolation can occur during right superior pulmonary vein (RSPV) ablation using pulsed-field ablation (PFA). However, the persistence of these abnormalities and their clinical associations with atrial tachyarrhythmias remain unclear. Herein, we assessed the persistence of low-voltage area (LVA) within SVCs, initially identified following the index procedure, and their associations with atrial tachyarrhythmias documented at repeat intervention across 25 patients with atrial fibrillation (AF) who underwent a repeat procedure after pulmonary vein isolation (PVI) using PFA. METHODS AND RESULTS: A de novo SVC LVA occurred in 20 of 25 patients (80%) after the index procedure. At the repeat procedures, performed after a median of 155 days, SVC LVA persisted in 13 of 20 patients (65%). Patients with persistent SVC LVA exhibited a shorter SVC-RSPV distance on preprocedural computed tomography than those without persistence (3.2 vs. 5.1 mm, p = 0.013). Residual LVA in the SVC was associated with colocalization with an atrial tachycardia isthmus in one patient and SVC-triggered AF in another. CONCLUSION: SVC LVA after PVI using PFA frequent occurred and persisted in approximately two-thirds of the patients, particularly when SVC and RSPV proximity was close. PFA-related collateral effects may facilitate atrial tachyarrhythmias.