Botis M, Tsiachris D, Doundoulakis I, Kordalis A, Antoniou CK, Chiotis S, Tsioufis P, Chierchia GB, de Asmundis C, Tsioufis K. Superior vena cava isolation is associated with improved outcomes in atrial fibrillation ablation. World J Cardiol 2026; 18(5): 118482 [DOI: 10.4330/wjc.v18.i5.118482]
Corresponding Author of This Article
Dimitrios Tsiachris, MD, PhD, Assistant Professor, First Department of Cardiology, National and Kapodistrian University of Athens, “Hippokration” General Hospital, Vas Sofias 114, Athens 11527, Greece. dtsiachris@yahoo.com
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Cardiac & Cardiovascular Systems
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Meta-Analysis
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May 26, 2026 (publication date) through May 20, 2026
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World Journal of Cardiology
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1949-8462
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Botis M, Tsiachris D, Doundoulakis I, Kordalis A, Antoniou CK, Chiotis S, Tsioufis P, Chierchia GB, de Asmundis C, Tsioufis K. Superior vena cava isolation is associated with improved outcomes in atrial fibrillation ablation. World J Cardiol 2026; 18(5): 118482 [DOI: 10.4330/wjc.v18.i5.118482]
World J Cardiol. May 26, 2026; 18(5): 118482 Published online May 26, 2026. doi: 10.4330/wjc.v18.i5.118482
Superior vena cava isolation is associated with improved outcomes in atrial fibrillation ablation
Michail Botis, Dimitrios Tsiachris, Ioannis Doundoulakis, Athanasios Kordalis, Christos Konstantinos Antoniou, Sotirios Chiotis, Panagiotis Tsioufis, Gian Battista Chierchia, Carlo de Asmundis, Konstantinos Tsioufis
Michail Botis, Dimitrios Tsiachris, Ioannis Doundoulakis, Athanasios Kordalis, Sotirios Chiotis, Panagiotis Tsioufis, Konstantinos Tsioufis, First Department of Cardiology, National and Kapodistrian University of Athens, “Hippokration” General Hospital, Athens 11527, Greece
Christos Konstantinos Antoniou, Athens Heart Center, Athens Medical Center, Athens 15125, Greece
Gian Battista Chierchia, Carlo de Asmundis, Heart Rhythm Management Centre, UZ Brussel-Vrije Univ Brussel, Brussels 1090, Brussels-Capital Region, Belgium
Co-first authors: Michail Botis and Dimitrios Tsiachris.
Author contributions: Tsiachris D and Botis M contributed equally to this manuscript and are co-first authors. Tsiachris D, Doundoulakis I, and Botis M contributed to conceptualization; Botis M and Tsiachris D contributed to methodology; Kordalis A and Antoniou CK contributed to formal analysis; Chiotis S contributed to investigation; Tsiachris D contributed to resources, writing - review and editing; Doundoulakis I contributed to data curation and visualization; Botis M contributed to writing - original draft preparation; Chierchia GB and de Asmundis C contributed to supervision; Tsioufis K and Tsiachris D contributed to project administration. All authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Dimitrios Tsiachris, MD, PhD, Assistant Professor, First Department of Cardiology, National and Kapodistrian University of Athens, “Hippokration” General Hospital, Vas Sofias 114, Athens 11527, Greece. dtsiachris@yahoo.com
Received: January 4, 2026 Revised: February 11, 2026 Accepted: April 3, 2026 Published online: May 26, 2026 Processing time: 136 Days and 9.2 Hours
Abstract
BACKGROUND
Pulmonary vein (PV) isolation is the mainstay in atrial fibrillation (AF) ablation. However, additional arrhythmogenic foci seem to contribute to AF initiation and maintenance. A great proportion of those non-PV foci have been reported to be located in the superior vena cava (SVC).
AIM
To investigate the effectiveness of SVC as an adjunctive therapy to PV isolation.
METHODS
We performed a meta-analysis of MEDLINE and CENTRAL. Inclusion criteria were cohort studies with a control group or randomized clinical trials, comparing patients undergoing AF ablation without additional SVC isolation to those receiving ablation with concurrent SVC isolation, in effects of freedom from atrial tachycardia.
RESULTS
A total of 10 studies, incorporating 2176 patients, were included. The majority of the patients (91.5%) expressed paroxysmal AF. The additional SVC isolation strategy in patients undergoing AF ablation was more effective than the non-SVC isolation strategy [odds ratio (OR) = 0.71; 95% confidence interval (CI): 0.55-0.92]. In a subgroup analysis, radiofrequency ablation demonstrated effectiveness (OR = 0.69; 95%CI: 0.53-0.92). Conversely, the use of cryoablation did not alter clinical outcomes (OR = 0.69; 95%CI: 0.13-3.61). In a distinct subgroup analysis, SVC isolation guided by induction of SVC-originating AF triggers - vs no isolation when no AF-inducing triggers were observed - yielded no superiority (OR = 0.73; 95%CI: 0.46-1.16).
CONCLUSION
The outcomes of AF ablation are favorable when additional SVC isolation is conducted. In a tailored care approach, radiofrequency energy should be preferred. Periprocedural induction of SVC-originating AF triggers, either by isoproterenol infusion or burst atrial pacing, should not be used as a criterion for performing SVC isolation. These findings support integrating SVC isolation into individualized ablation strategies to optimize patient outcomes.
Core Tip: In patients with superior vena cava (SVC) potentials, additional SVC isolation is accompanied by reduced rates of tachycardia recurrence during atrial fibrillation ablation. In a tailored care approach, radiofrequency energy has proven better results compared to cryoablation-mediated SVC isolation. The strategy of periprocedural induction of SVC-originating atrial fibrillation should not be used as a criterion for deciding SVC isolation. These findings support integrating SVC isolation into individualized ablation strategies to optimize patient outcomes.
