SVC isolation

[Frances123]

I was sorting papers the other day and came across my discharge letter of August 2021 after RF ablation. I read it thoroughly at the time but obviously missed or didn’t register the following… 2 x AF ablation - initial cryo with redo AF and SVC isolation… What SVC isolation? What is SVC isolation? This was never mentioned before, after or since. I’ve have looked it up and understand roughly what it means but unsure why it was performed, especially as there has never been any mention of it. Can anyone enlighten me please.

[SeanJax]

your ep is very good to detect the rogue source from the mapping. SVC is superior vena cava near the sinus node and it is a big frequent source of Afib in addition of pulmonary veins. Refer patients to him. He is good . One mistake you would need a pace maker for life.

[mjames1 in reply to SeanJax]

Yes, if it was done because of mapping and not done empirically (by other evidence). Empirical SVC isolation has not been shown superior to just a PVI, but as you state has additional risks. One of my ep's actually uses Cryo for SVT ablations near the AV node, which apparently lessens the risk of needing a pacemaker.

Jim

[Frances123 in reply to mjames1]

Thanks. I believe it was done by mapping.

[Frances123 in reply to SeanJax]

Thank you. Yes he was good. Dr Derek Todd at Liverpool Heart and Chest Hospital.

[mjames1]

Confusing. Either you first had a cryo ablation and then they did a second touch up ablation using RF on the pulmonary veins (left side) and then did a Superior Vena Cava ablation on the right side. If this was your only ablation, then it probably means Cryo used on the left and RF used on the right. In any event, best ask your doctor.

Jim

[Frances123 in reply to mjames1]

Thanks. I had had a cryoablation previously. As it said 2xAF ablation-initial cryo etc. I not bothered as I know it must have been done for a good reason. Just a surprise to find out this way.

[mjames1 in reply to Frances123]

If it was done via mapping, the ep probably didn't know until he was inside. You would think they would tell you the plan in advance, but they often don't. In any event, sounds like the right thing was done.

Jim

[Frances123 in reply to mjames1]

Sadly though both ablations have failed.

[mjames1 in reply to Frances123]

Sorry to hear. Depending on your afib burden and other factors, you might look into surgical ablations like the MiniMaze or Hybrid/Convergent. They sometimes work when catheter ablations fail. MummyLuv is a good resource on that in the UK.

Jim

[BobD Volunteer in reply to mjames1]

The note states 2 x ablations first Cryo second RF (but typed as AF)

[Frances123 in reply to BobD]

Thanks Bob.