Combining PVI with SVCI shows a measurable reduction in AF recurrence. The meta-analysis, published in Circulation, examined whether targeting a known non-pulmonary trigger improves rhythm outcomes beyond standard PVI.

The review included five randomized controlled trials with a total of 700 individuals, with 337 receiving PVI plus SVCI and 363 receiving PVI alone. Pooled fixed-effect analyses showed reduced odds of total AF recurrence with combined ablation, with an odds ratio (OR) of 0.68 and a 95% confidence interval (CI) of 0.47 to 0.99. Paroxysmal AF recurrence declined further, with an OR of 0.55 and a 95% CI of 0.35 to 0.86.

Despite the reduction in recurrence, procedural variables did not differ between groups. Fluoroscopy time and total procedure duration showed no significant differences. Complication rates were similar, with an OR of 1.07 and a 95% CI of 0.35 to 3.29. TSA confirmed conclusive evidence only for fluoroscopy time. Outcomes related to recurrence and procedural duration remained statistically inconclusive because of limited cumulative sample size.

These findings support a potential role for SVCI in reducing AF recurrence, particularly in paroxysmal AF. However, the inconclusive TSA results underscore the need for larger, adequately powered trials before routine integration of SVCI into ablation workflows.