Predictors of Ectopic Firing from Superior Vena Cava in Patients with Paroxysmal Atrial Fibrillation

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Background: The ectopic firing from superior vena cava (SVC) can initiate paroxysmal atrial fibrillation (PAF) in some patients and play an important role for recurrence of PAF after pulmonary vein isolation (PVI). The predictors of SVC firing is unknown. Methods: The subjects were 336 consecutive PAF patients (278 male, age 56.1±10.8 years) undergoing AF ablation. In addition to PVI, SVC isolation was performed only in patients with documented SVC firing. We compared the clinical factors between patients with and without SVC firing. Results: SVC firing was observed in 43/336 (12.8%) patients and complete isolation of SVC was performed in all of them. Lower body mass index (BMI) (22.8±2.8 vs 24.1±3.1 kg/m2, p=0.007), higher number of prior ablation procedure (0.74±0.73 vs 0.19±0.41, p<0.0001) and higher brain natriuretic peptide value (78.1±140.7 vs 53.1±62.4 pg/ml, p=0.05) were related to the presence of SVC firing. In a multivariate analysis, lower BMI (p=0.012; odds ratio 0.83, 95% CI 0.72 to 0.96) and history of prior ablation procedure (p<0.0001; odds ratio 5.37, 95% CI 2.71 to 10.63) predicted the occurrence of SVC firing. The incidence of subsequent AF recurrence was similar between patients with and without SVC firing (14.0% vs 12.3%, respectively, p=ns). Conclusions: SVC firing was associated with the repeat ablation procedures and lower BMI.