Successful Pulsed-field Ablation of Superior Vena Cava Fibrillation Using a Circular Multielectrode Array Catheter (JACC Case Reports July 2025)-Article: Successful Pulsed-field Ablation of Superior Vena Cava Fibrillation Using a Circular Multielectrode Array Catheter

Article: Successful Pulsed-field Ablation of Superior Vena Cava Fibrillation Using a Circular Multielectrode Array Catheter

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This case series evaluates the feasibility and safety of superior vena cava isolation (SVCI) using a circular multielectrode array pulsed-field ablation (PFA) catheter for treating atrial fibrillation (AF) triggered by non-pulmonary vein foci located in the superior vena cava (SVC). Traditionally, SVCI with thermal energy carries risks of phrenic nerve palsy and sinus node dysfunction due to collateral damage. Pulsed-field ablation, a nonthermal technique applying ultrashort electrical pulses, selectively ablates myocardial tissue while sparing surrounding structures like the phrenic nerve and esophagus, offering a potential safety advantage.<br /><br />In this observational study at Saiseikai Fukuoka General Hospital, 11 patients underwent SVCI using the PulseSelect circular multielectrode PFA catheter when ectopic triggers originated in the SVC or myocardial sleeves were sufficiently long. A mean of 7.8 PFA applications achieved circumferential isolation approximately 2 cm above the sinus node to avoid sinus node injury. Detailed 3D mapping, including fractionation mapping, was employed to identify arrhythmogenic SVC areas and safeguard conduction from the sinus node.<br /><br />The procedure successfully terminated AF or atrial tachycardia originating from the SVC in all patients with no recurrences during follow-up. Importantly, no instances of sinus node dysfunction or persistent phrenic nerve palsy occurred post-procedure, contrasting with previous thermal energy ablations where such complications were reported. Heart rates and earliest activation sites remained stable, confirming preservation of sinus node function. The targeted lesion formation was validated via pre- and post-ablation voltage mapping.<br /><br />This report is the first to document SVCI using a circular multielectrode PFA catheter in humans, demonstrating both effectiveness and safety. The findings suggest that PFA may overcome limitations of thermal ablation by reducing collateral damage, particularly to the phrenic nerve and sinus node. Limitations include the small sample size and inability to monitor phrenic nerve function intra-procedurally due to catheter removal during energy delivery.<br /><br />In conclusion, circumferential SVCI with a circular multielectrode array PFA catheter is a promising strategy for treating AF triggered by superior vena cava foci, with a favorable safety profile. Larger studies with long-term follow-up are needed to confirm these preliminary results.

Keywords

superior vena cava isolation

pulsed-field ablation

circular multielectrode array catheter

atrial fibrillation

non-pulmonary vein foci

phrenic nerve palsy

sinus node dysfunction

3D mapping

fractionation mapping

Saiseikai Fukuoka General Hospital