Long‐Term Follow‐Up of Superior Vena Cava–Right Atrium Spontaneous Conduction Block Line Durability Using the White‐Line Approach of Extended Early Meets‐Late Rate Tools

ABSTRACT Background Superior vena cava (SVC)–right atrium (RA) spontaneous conduction block occurs in some patients. We demonstrated a novel approach for SVC isolation using visualization of the SVC–RA conduction block line as a white line with the extended early meets‐late (EEML) tool of the CARTO...

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Main Authors: Yoshiaki Mizunuma, Masao Takahashi, Takafumi Sasaki, Koichiro Yamaoka, Hirofumi Kujiraoka, Tomoyuki Arai, Rintaro Hojo, Seiji Fukamizu
Format: Article
Language:English
Published: Wiley 2025-08-01
Series:Journal of Arrhythmia
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Online Access:https://doi.org/10.1002/joa3.70161
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author Yoshiaki Mizunuma
Masao Takahashi
Takafumi Sasaki
Koichiro Yamaoka
Hirofumi Kujiraoka
Tomoyuki Arai
Rintaro Hojo
Seiji Fukamizu
author_facet Yoshiaki Mizunuma
Masao Takahashi
Takafumi Sasaki
Koichiro Yamaoka
Hirofumi Kujiraoka
Tomoyuki Arai
Rintaro Hojo
Seiji Fukamizu
author_sort Yoshiaki Mizunuma
collection DOAJ
description ABSTRACT Background Superior vena cava (SVC)–right atrium (RA) spontaneous conduction block occurs in some patients. We demonstrated a novel approach for SVC isolation using visualization of the SVC–RA conduction block line as a white line with the extended early meets‐late (EEML) tool of the CARTO system. The long‐term durability of SVC isolation using white line has not been investigated. Methods Overall, 200 patients who underwent SVC isolation as atrial fibrillation therapy or additional procedures between May 2015 and April 2024 were included. We created an activation map of sinus rhythm, adjusted the EEML settings, and confirmed the white line. In the presence of a white line, we performed SVC isolation using the white line (block group); in its absence, we conducted encircling SVC isolation (nonblock group). If additional procedures were needed at follow‐up, repeat sessions were performed to identify the treatment targets, and SVC–RA mapping was performed. SVC–RA block line durability was defined as the SVC isolated area by voltage map at the additional session, including the white line of the first session. The SVC reconduction number between the two groups was compared, and SVC–RA spontaneous block line durability was confirmed in the block group. Results Thirty‐one of 200 patients underwent additional procedures and follow‐up SVC–RA mapping. The chronic SVC reconduction ratio did not differ significantly between the two groups. SVC–RA spontaneous block line durability was maintained in all patients in the block line group (block group 12/12 [100%]). Conclusion SVC–RA spontaneous block visualized by using the white‐line approach of EEML tools had durability in the chronic phase.
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spelling doaj-art-816dd3d62a6744cabf7d8fe7eea8373f2025-08-26T10:38:54ZengWileyJournal of Arrhythmia1880-42761883-21482025-08-01414n/an/a10.1002/joa3.70161Long‐Term Follow‐Up of Superior Vena Cava–Right Atrium Spontaneous Conduction Block Line Durability Using the White‐Line Approach of Extended Early Meets‐Late Rate ToolsYoshiaki Mizunuma0Masao Takahashi1Takafumi Sasaki2Koichiro Yamaoka3Hirofumi Kujiraoka4Tomoyuki Arai5Rintaro Hojo6Seiji Fukamizu7Department of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo JapanDepartment of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo JapanDepartment of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo JapanDepartment of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo JapanDepartment of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo JapanDepartment of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo JapanDepartment of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo JapanDepartment of Cardiology Tokyo Metropolitan Hiroo Hospital Tokyo JapanABSTRACT Background Superior vena cava (SVC)–right atrium (RA) spontaneous conduction block occurs in some patients. We demonstrated a novel approach for SVC isolation using visualization of the SVC–RA conduction block line as a white line with the extended early meets‐late (EEML) tool of the CARTO system. The long‐term durability of SVC isolation using white line has not been investigated. Methods Overall, 200 patients who underwent SVC isolation as atrial fibrillation therapy or additional procedures between May 2015 and April 2024 were included. We created an activation map of sinus rhythm, adjusted the EEML settings, and confirmed the white line. In the presence of a white line, we performed SVC isolation using the white line (block group); in its absence, we conducted encircling SVC isolation (nonblock group). If additional procedures were needed at follow‐up, repeat sessions were performed to identify the treatment targets, and SVC–RA mapping was performed. SVC–RA block line durability was defined as the SVC isolated area by voltage map at the additional session, including the white line of the first session. The SVC reconduction number between the two groups was compared, and SVC–RA spontaneous block line durability was confirmed in the block group. Results Thirty‐one of 200 patients underwent additional procedures and follow‐up SVC–RA mapping. The chronic SVC reconduction ratio did not differ significantly between the two groups. SVC–RA spontaneous block line durability was maintained in all patients in the block line group (block group 12/12 [100%]). Conclusion SVC–RA spontaneous block visualized by using the white‐line approach of EEML tools had durability in the chronic phase.https://doi.org/10.1002/joa3.70161atrial fibrillationCARTOcatheter ablationright atriumsuperior vena cava
spellingShingle Yoshiaki Mizunuma
Masao Takahashi
Takafumi Sasaki
Koichiro Yamaoka
Hirofumi Kujiraoka
Tomoyuki Arai
Rintaro Hojo
Seiji Fukamizu
Long‐Term Follow‐Up of Superior Vena Cava–Right Atrium Spontaneous Conduction Block Line Durability Using the White‐Line Approach of Extended Early Meets‐Late Rate Tools
Journal of Arrhythmia
atrial fibrillation
CARTO
catheter ablation
right atrium
superior vena cava
title Long‐Term Follow‐Up of Superior Vena Cava–Right Atrium Spontaneous Conduction Block Line Durability Using the White‐Line Approach of Extended Early Meets‐Late Rate Tools
title_full Long‐Term Follow‐Up of Superior Vena Cava–Right Atrium Spontaneous Conduction Block Line Durability Using the White‐Line Approach of Extended Early Meets‐Late Rate Tools
title_fullStr Long‐Term Follow‐Up of Superior Vena Cava–Right Atrium Spontaneous Conduction Block Line Durability Using the White‐Line Approach of Extended Early Meets‐Late Rate Tools
title_full_unstemmed Long‐Term Follow‐Up of Superior Vena Cava–Right Atrium Spontaneous Conduction Block Line Durability Using the White‐Line Approach of Extended Early Meets‐Late Rate Tools
title_short Long‐Term Follow‐Up of Superior Vena Cava–Right Atrium Spontaneous Conduction Block Line Durability Using the White‐Line Approach of Extended Early Meets‐Late Rate Tools
title_sort long term follow up of superior vena cava right atrium spontaneous conduction block line durability using the white line approach of extended early meets late rate tools
topic atrial fibrillation
CARTO
catheter ablation
right atrium
superior vena cava
url https://doi.org/10.1002/joa3.70161
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