Electroanatomic Mapping and Catheter Ablation of Breakthroughs From the Right Atrium to the Superior Vena Cava in Patients With Atrial Fibrillation

Abstract

Background-The superior vena cava (SVC) is one of the sources of ectopies that can initiate atrial fibrillation (AF). We investigated by radiofrequency ablation the electrophysiological characteristics of the junction of the right atrium (RA) and the SVC and the feasibility of electrical disconnection of the SVC from the RA. Methods and Results-Sixteen patients with paroxysmal AF after pulmonary vein isolation underwent electroanatomic mapping at the RA-SVC junction during sinus rhythm. Mapping showed sharp potentials (SVC potentials) inside the SVC. Activation spread from the earliest SVC potential (breakthrough) to the rest of the SVC. SVC potentials were found over a large amount of the circumference, suggesting widespread muscle coverage of the SVC. Breakthroughs from the RA to SVC were located anteriorly, laterally, posteriorly, and septally in 3, 4, 10, and 6 patients, respectively. The number of breakthroughs was 1.4Ϯ0.5 per patient. Radiofrequency energy was applied with the end point of electrical disconnection. All breakthroughs were eliminated with 3.1Ϯ1.7 applications per breakthrough without complications. Conclusions-SVC potentials can be recorded inside the SVC. There are specific breakthroughs from the RA to the SVC that can be identified by electroanatomic mapping. The electrical disconnection of the SVC from the RA is feasible.

Conduction Recovery After Electrical Isolation of Superior Vena Cava

“…7 Goya et al reported breakthroughs between the SVC and RA in 16 patients. 25 They were located in the anterior aspect of the RA-SVC junction in 3, laterally in 4, posteriorly in 10, and septally in 6 patients. In the present study the most likely location of SVC reconnection was the anterolateral SVC-RA junction.…”

High Atrial Defibrillation Threshold With Internal Cardioversion Indicates Arrhythmogenicity of Superior Vena Cava in Non-Long-Standing Persistent Atrial Fibrillation

“…The SVC is a structure second only to the PV in importance for treating AF. 8, [20][21][22][23][24][25][26] xternal cardioversion (EC) is sometimes used for terminating drug-refractory atrial fibrillation (AF) and is recognized as a useful treatment option for it. 1,2 Internal cardioversion (IC) is an alternative treatment that can be more effective and which delivers lower joule energy than EC.…”

Clinical Profile and Prognosis of Patients with Right Ventricular Dilated Cardiomyopathy: Results of a Prospective Study

“…The revealed features seemingly contradict the common pathogenesis mechanisms according to which the AF occurrence is mainly due to the appearance of abnormal impulses in LA remodeling from the mouths of the pulmonary veins and throughout the tissue. Nevertheless, the superior vena cava is one of the sources of ectopies that can initiate AF, which was determined in a study performed by M.Goya et al [23]. Gaynor SL et al [24] showed that in dogs with chronic RV pressure overload, RV systolic function was preserved, but diastolic function was impaired.…”