Abstract

Atrial fibrillation (AF) most commonly arises from the pulmonary veins; however, triggers originating from the superior vena cava have also been shown to contribute significantly. Clinical evidence regarding the additional isolation of the superior vena cava during pulmonary vein isolation (PVI) procedures remains inconsistent, particularly in terms of its benefits and associated complications. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines to identify studies examining the association between PVI and the addition of superior vena cava isolation (SVCI). Trial Sequential Analysis was performed applying O’Brien-Fleming monitoring boundaries. A total of 724 records were screened, of which five met the inclusion criteria. Sample sizes ranged from 48 to 134 patients in the group receiving PVI+SVCI, and from 49 to 160 patients in the group receiving PVI alone. The addition of SVCI to PVI was associated with a significant reduction in both overall AF recurrence (OR = 0.68) and paroxysmal AF (PAF) recurrence (OR = 0.55). No significant differences were observed between groups in fluoroscopy time or complication rates. Trial Sequential Analysis suggested that the addition of SVCI to PVI might reduce AF recurrence, particularly the PAF, without increasing procedural risk. However, the analysis also indicated that the cumulative evidence remains insufficient, and more definitive trials are needed to confirm these findings.

Key words: Atrial fibrillation ablation, pulmonary vein isolation, superior vena cava isolation, Trial sequential analysis, systematic review, meta-analysis