Europace Advance Access originally published online on June 8, 2007
Europace 2007 9(9):775-780; doi:10.1093/europace/eum118
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CATHETER ABLATION
Electrogram-guided isolation of the left superior vena cava for treatment of atrial fibrillation
1 Department of Cardiology, Royal Perth Hospital, Wellington Street, GPO Box X2213, Perth 6847, Western Australia, Australia; 2 Department of Medical Imaging, Royal Perth Hospital, Wellington Street, Perth, Western Australia, Australia; 3 Department of Medicine, University of Western Australia, Crawley, Western Australia, Australia
Aims Radiofrequency ablation targeting the pulmonary veins offers potential cure for patients with symptomatic paroxysmal atrial fibrillation (AF). Initiating ectopics can also arise from other sites including the major thoracic veins, vein of Marshall and more rarely, persistent left superior vena cava (LSVC). We report our experience with arrhythmogenic persistent LSVC initiating AF.
Methods and results The LSVC was present in four patients from an overall series of 204 patients undergoing AF ablation at our centre. All were males, mean age 50 ± 11 years. All patients underwent pre-procedure transesophageal echocardiography. The mapping of the LSVC was performed with a circumferential mapping catheter following pulmonary vein isolation. Atrial ectopics from the LSVC were observed to initiate AF. Catheter ablation (power controlled mode; 65°C and 30 W at irrigation flow rate of 30 mL/min) resulted in electrical isolation of the LSVC in all patients and was accompanied by termination of AF in one of four patients. There were no complications. All patients underwent multiple procedures (three procedures in one patient, two procedures in three patients). After a mean follow-up of 18 ± 7 months (range 7–24 months), three of the four patients remained free of AF off antiarrhythmic medications.
Conclusion Arrhythmogenic foci within persistent LSVC can result in AF despite electrical isolation of pulmonary veins. This report demonstrates the importance of the LSVC as a potential source of atrial ectopics initiating and perpetuating AF.
Key Words: Catheter, Ablation, Atrial fibrillation
* Corresponding author. Tel: +61 8 9224 2244; fax: +61 8 9224 3175. E-mail address: rukshen{at}gmail.com
Manuscript submitted 8 December 2006. Accepted after revision 3 May 2007.
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  M. A.E. Schneider, A. Schade, M. L. Koller, and B. Schumacher Cryoballoon ablation of paroxysmal atrial fibrillation within the dilated coronary sinus in a case of persistent left superior vena cava Europace, October 1, 2009; 11(10): 1387 - 1389. [Abstract] [Full Text] [PDF]
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