Standardised superior vena cava isolation with a balloon-in-basket pulsed-field ablation catheter: feasibility and acute safety of two procedural workflows in 53 consecutive patients.

PURPOSE: Pulsed-field ablation (PFA) is established for pulmonary vein isolation, but data on superior vena cava (SVC) isolation are limited. We assessed the feasibility and acute safety of SVC isolation with the Volt™ balloon-in-basket PFA catheter using two sequentially applied standardised workflows.

METHODS

Retrospective single-centre series of 53 consecutive patients undergoing atrial fibrillation ablation with adjunctive SVC isolation. Workflow 1 (n = 28) used phrenic-nerve pacing and tailored energy; Workflow 2 (n = 25) used low-energy PFA only without phrenic pacing; both shared mapping-guided sinus-node sparing and a 20-second flow-preservation manoeuvre. A pre-specified within-platform sensitivity analysis controlled for a concurrent catheter iteration (20 January 2026).

RESULTS

Acute SVC isolation was achieved in all 53 patients (100%, 95% CI 93.3-100%). No phrenic-nerve injury and no permanent atrioventricular block occurred (0/53); one Workflow 1 patient had transient junctional rhythm that resolved spontaneously. Workflow-attributable differences were confined to SVC-specific metrics and persisted within a single catheter-platform era: Workflow 2 used low-energy applications exclusively, required more applications (median 5 vs. 4; p = 0.010), and had a longer SVC isolation time (10.7 vs. 8.5 min; p = 0.006). Shorter procedure and fluoroscopy times in Workflow 2 did not persist within a single catheter-platform era (p = 0.94, p = 0.35). Median follow-up 84 days (data censored 1 July 2026).

CONCLUSIONS

SVC isolation with the Volt™ balloon-in-basket PFA catheter is feasible with favourable acute safety. A simplified low-energy-only protocol without phrenic-nerve pacing is a reasonable alternative to a phrenic-paced tailored-energy protocol. Durability and rhythm outcomes require dedicated follow-up study.