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Europace Advance Access published online on October 31, 2009
Europace, doi:10.1093/europace/eup325
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

SHORT COMMUNICATION

Left superior vena cava conduction to the left atrium unmasked by adenosine in a patient with paroxysmal atrial fibrillation during pulmonary vein isolation

François Regoli1,2,*, Santi Raffa1, Anett Große1, Michele Brunelli1 and J. Christoph Geller1

1 Division of Cardiology, Arrhythmia and Electrophysiology Section, Zentralklinik Bad Berka, Germany; 2 Division of Cardiology, Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland

Abstract

The use of adenosine in unmasking potential ‘trigger' activity in a patient with paroxysmal atrial fibrillation (AF) and persistent left superior vena cava (LSVC) has never been reported.

In a 75-year-old woman with paroxysmal AF and LSVC anomaly, pulmonary vein isolation (PVI) procedure was performed. After successful PVI, repeated bolus adenosine infusions were given. Adenosine response originating from the LSVC was observed: it was reproducible, brief, and exhibited decremental atrial-to-LSVC conduction properties until cessation. Pacing from the LSVC resulted in atrial capture (confirming vein-to-atrium conduction). Disconnection of the LSVC from the coronary sinus (CS) was obtained by successfully ablating within the distal CS. Adenosine challenge may be important to identify AF triggers in non-PVI foci.

* Corresponding author. Tel.: +41 901 805 3351, Fax: +41 91 805 3167. Email: francois.regoli{at}cardiocentro.org

Manuscript submitted 18 July 2009. Accepted after revision 27 September 2009.


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