Electrogram-guided isolation of the left superior vena cava for treatment of atrial fibrillation

Abstract

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.

Superior vena cava as initiator of atrial fibrillation: Factors related to its arrhythmogenicity

“…[1][2][3][4][5] However, ectopic beats initiating AF sometimes arise from non-PV foci, such as the superior vena cava (SVC), left atrial (LA) posterior free wall, ligament of Marshall, crista terminalis, and coronary sinus. [6][7][8][9] Because the SVC accounts for the major portion of non-PV foci, 6,10,11 SVC isolation in addition to PV isolation reduces the recurrence of AF. 12 It would be extremely useful clinically if patients requiring SVC isolation could be distinguished from those not requiring SVC isolation, but currently this ability is unclear.…”

Persistent Left Superior Vena Cava in Patients Undergoing Cardiac Device Implantation: Clinical and Long-Term Data

“…Patients with a persistent LSVC may become symptomatic due to arrhythmias through fragmentation and stretching of the conduction tissue by dilated coronary sinus or ectopic pacemaker cells [2, 17]. The presence of sinus node dysfunction observed in our 2 patients with persistent LSVC could also reflect a mal development of the sinus node, or a lesion of its nutrient artery [18].…”

“…The presence of sinus node dysfunction observed in our 2 patients with persistent LSVC could also reflect a mal development of the sinus node, or a lesion of its nutrient artery [18]. There is some evidence that LSVC, as a source of ectopy, can initiate AF in patients with persistent LSVC despite previous pulmonary vein isolation [17, 19]. In such patients, Hsu et al found electrical connections between LSVC and coronary sinus and LSVC and left atrium [19].…”

Cardiac Stomach: A Giant Coronary Sinus with Persistent Left Superior Vena Cava and Severe Tricuspid Regurgitation

“…In patients with accompanying congenital heart disease, their long term course is mostly influenced by particular congenital defect(s) [7]. The development of symptoms related to cardiac arrhythmia via secondary stretching of the conduction tissue surrounding the dilated CS has also been reported [8,9]. However, Should a PLSVC drain directly into the left atrium (LA), or into an unroofed CS (such that there anomalous connection with the LA), a hemodynamically significant right-to left shunt may form.…”