Superior vena cava isolation is associated with improved outcomes in atrial fibrillation ablation

Table 1 Design and main characteristics of the eligible studies

Ref.	Type of study	Decision to ablate	Isolation technique	Primary outcome
Wang et al[18], 2008	Single-center, randomized	Randomization, prior to EP study and catheter ablation	Radiofrequency ablation	Atrial tachycardia recurrence
Corrado et al[19], 2010	Single-center, randomized	Randomization, without investigating SVC triggers with provocative maneuvers; if SVC spontaneous potentials were not recorded, no SVC electrical isolation was conducted	Radiofrequency ablation	Maintenance of sinus rhythm without antiarrhythmic drugs
Da Costa et al[20], 2015	Single-center, randomized	Randomization was conducted at the time of the procedure, if the mapping catheter above the right atrium-SVC junction revealed active electrical potentials in the SVC, under sinus rhythm, or under stimulation	Radiofrequency ablation	Freedom from atrial tachycardia and atrial fibrillation
Muto et al[21], 2007	Single-center, observational, prospective	SVC isolation was performed when spontaneous AF originating from the SVC was observed, with reproducibility via isoproterenol infusion and burst atrial pacing	Radiofrequency ablation	Occurrence of electrical connection recovery after segmental ostial isolation in patients with recurrent atrial fibrillation for SVC vs PV
Higuchi et al[10], 2010	Single-center, observational, prospective	SVC isolation was performed if AF triggers originated from the SVC, after AF induction with high-frequency pacing and intravenous isoproterenol infusion	Radiofrequency ablation	Identification of structural and electrophysiologic differences between the SVC of patients with and without SVC triggering of SVC (length of sleeve, voltage)
Takigawa et al[22], 2017	Single-center, observational, prospective	SVC isolation was performed if sustained or non-sustained AF was reproducibly initiated from SVC foci, after isoproterenol infusion or rapid atrial pacing	Radiofrequency ablation	Atrial fibrillation recurrence
Overeinder et al[23], 2021	Single center, observational-retrospective	SVC isolation was performed if electrical activity was documented in the SVC prior to ablation	Cryoballoon ablation	Freedom from atrial tachycardia
Dong et al[24], 2024	Multi-center, randomized	Before randomization, isoproterenol or adenosine triphosphate infusion and rapid burst pacing were used to reveal SVC AF triggers; thirty patients exhibited SVC-triggered AF and underwent SVC electrical isolation; one hundred patients did not exhibit SVC-originated AF triggers and were randomized to PV isolation vs PV isolation and SVC electrical isolation; in the overall analysis, the 80 patients who underwent SVC isolation were compared with the 50 patients who did not undergo SVC isolation; in the subgroup analysis of studies where SVC isolation was conducted after induction of SVC-originating AF triggers with isoproterenol infusion or burst pacing, 30 patients who exhibited SVC-induced AF after isoproterenol infusion or burst pacing were compared with 50 patients who did not exhibit SVC-induced AF and did not undergo SVC electrical isolation	Radiofrequency ablation	Freedom from any documented atrial tachycardia
Castro-Urda et al[25], 2025	Single-center, randomized	The decision to electrically isolate the SVC was taken according to the presence of spontaneous SVC potentials	Cryoballoon ablation	Freedom from atrial fibrillation/atrial flutter/atrial tachycardia
Shen et al[26], 2025	Multi-center, randomized	Randomization to PV isolation plus SVC isolation or solely PV isolation. SVC isolation was conducted in the presence of SVC potentials	Radiofrequency ablation	Freedom from atrial arrhythmias

SVC: Superior vena cava; PV: Pulmonary vein; AF: Atrial fibrillation.

Table 2 Baseline characteristics of the patients included

Ref.	Country	Total number of patients	Follow up (months)	Atrial fibrillation type	Age1	Left atrium diameter (mm)	Gender (male)	CHA2DS2-VASC/CHADS2 score
Wang et al[18], 2008	China	106	4 ± 2	100% paroxysmal	66.0 ± 8.8	32.85 ± 8.96	52.8%	NR
Corrado et al[19], 2010	Italy	320	12	46% paroxysmal; 23% persistent; 31% long-standing persistent AF	56 ± 4.25	45.76 ± 0.94	67.8%	NR
Da Costa et al[20], 2015	France	100	15 ± 8	100% paroxysmal	56 ± 9	42 ± 2	83%	0.9 ± 1
Muto et al[21], 2007	Japan	95	6	100% paroxysmal	58.47 ± 11	35 ± 5	54.7%	NR
Higuchi et al[10], 2010	Japan	60	12	76.67% paroxysmal; 23.33% persistent	59.2 ± 10	38 ± 4.67	76.67%	NR
Takigawa et al[22], 2017	Japan	865	53.5 ± 39.1	100% paroxysmal	61 ± 10	36.62 ± 5.14	77.46%	0.8 ± 1 (CHADSC score)
Overeinder et al[23], 2021	Belgium	100	12	100% paroxysmal	55.3 ± 5.84	32.85 ± 8.96	68%	1 ± 1
Dong et al[24], 2024	China, Singapore	130	12	100% paroxysmal	58.1 ± 4.7	37.85 ± 3.67	72.0%	1 ± 1
Shen et al[26], 2025	China	302	20	100% paroxysmal	64 (56.0-70.0)	NR	54.6%	2.4 ± 1

¹mean ± SD, median, and interquartile range.

AF: Atrial fibrillation; NR: Not reported.

Table 3 Percentage of redo procedures and reconnection rates

Ref.	Percent of repeat procedure in the SVC group	Any pulmonary vein reconnection percentage	SVC reconnection percentage	Percentage of repeat procedure in the non-SVC group	Any pulmonary reconnection percentage
Wang et al[18], 2008	16%	100%	0%	16.7%	77.8%
Corrado et al[19], 2010	NR	NR	NR	6.88%	NR
Muto et al[21], 2007	26.7%	NR	25%	31.3%	NR
Higuchi et al[10], 2010	0%			31.3%	100%
Takigawa et al[22], 2017	26.3%	60%	53.3%	30.1%	80.3%
Overeinder et al[23], 2021	10%	8%	0%	NR	NR
Castro-Urda et al[25], 2025	16.7%	77.7%	66.7%	20.4%	100%
Shen et al[26], 2025	NR			NR

SVC: Superior vena cava; NR: Not reported.