Second-Generation Cryoballoon Atrial Fibrillation Ablation in Patients With Persistent Left Superior Caval Vein

OBJECTIVES This study sought to assess the acute success rate, periprocedural complications, and tong-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. Mt 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 min and 32 +/- 18 min, respectively. In 2 of 8 patients, major complications (right phrenic nerve patsy) occurred during right PV ablation. After 3 months, 1 of 2 patients recovered from right phrenic nerve patsy. 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 patsy. Electrical isolation of PLSVC can be achieved with the CB2 in most patients. (C) 2019 by the American College of Cardiology Foundation.