Adjunctive Superior Vena Cava Isolation to Pulmonary Vein Isolation in Atrial Fibrillation Ablation: A Systematic Review and Meta-Analysis of Randomized Trials Publisher Pubmed



Alilou S ; Babaei M ; Fallahtafti P ; Castrourda V ; Oraii A ; Rashedi S ; Di Biase L
Source: Heart Rhythm Published:2026

Abstract

Background Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Nonpulmonary vein triggers, particularly from the superior vena cava, contribute to arrhythmogenesis in a subset of patients. The benefit of adjunctive superior vena cava isolation (SVCI) in addition to PVI remains uncertain. Objective This study aimed to assess the efficacy and safety of adjunctive SVCI in AF ablation. Methods We systematically searched PubMed, Embase, and ClinicalTrials.gov for randomized controlled trials comparing adjunctive SVCI plus PVI with PVI alone in adults undergoing first-time AF ablation. The main outcome was atrial tachyarrhythmia recurrence. Additional outcomes included procedure time, fluoroscopy time, and major and minor complications. Pooled odds ratios (ORs), hazard ratios, and 95% confidence intervals (CIs) were calculated using fixed- and random-effects models, with subgroup analyses by AF type and ablation modality. Results 7 randomized controlled trials involving 1149 patients were included. Adjunctive SVCI to PVI compared with PVI alone was associated with reduced atrial tachyarrhythmia recurrence (OR 0.71; 95% CI 0.53-0.96; I2 = 0%), confirmed by time-to-event analysis (hazard ratio 0.71; 95% CI 0.50-0.99). The effect was more pronounced in paroxysmal AF (OR 0.63; 95% CI 0.44-0.88) and with radiofrequency ablation (OR 0.66; 95% CI 0.47-0.93). SVCI plus PVI increased minor complications (13.7% vs 2.7%; OR 4.44; 95% CI 1.95-11.16), mainly transient phrenic nerve injury (6.8% vs 1.4%) and sinus node injury (1.6% vs 0%). Major complications were comparable (1.8% vs 1.0%). Conclusion Adjunctive SVCI to PVI vs PVI alone was associated with reduced atrial tachyarrhythmia recurrence but increased minor complications in AF ablation. © 2025 Heart Rhythm Society.