RADIOFREQUENCY CATHETER ABLATION TO PAROXYSMAL ATRIAL FIBRILLATION PATIENTS WITH PERSISTENT LEFT SUPERIOR VENA CAVA

K. Minami, Y. Nakatani, M. Nakano, K. Ikeda, T. Sasaki, K. Nakamura, K. Kumagai, S. Naito. S. Oshima

Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi City, Japan

Abstract

Introduction: Persistent left superior vena cava (PLSVC) is the embryological precursor of the ligament of Marshall, which has been implicated in the initiation and maintenance of atrial fibrillation (AF). However little clinical data about the relevance of PLSVC in paroxysmal AF are available.
Methods and Results: Between January 2005 and December 2012, seven patients (4 men; age 55 ± 9.9 years) with symptomatic drug-refractory AF and PLSVC received a catheter ablation in our institution. All patients had paroxysmal AF and received circumferential pulmonary vein isolation (PVI). PLSVC was mapped with a circumferential mapping catheter following PVI, and ectopics originating from PLSVC was documented in two patients. They received isolation of PLSVC because PLSVC had electrical connections to coronary sinus and left atrium. In four patients, there was no electrical potential in PLSVC. During follow-up of 16 ± 9.8 months, six of the seven patients were in sinus rhythm and free from AF.
Conclusions: PLSVC can be the arrythmogenic source of AF. PVI may not be sufficient to suppress AF in patients with PLSVC, thus PLSVC isolation should be considered.