Successful slow pathway ablation in a patient with persistent left superior vena cava

Silişte, Cǎlin; Margulescu, Andrei-Dumitru; Vinereanu, Dragoş

doi:10.1093/europace/eup296

Cited by 5 publications

(3 citation statements)

References 3 publications

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“…Although this distance seems enough in anatomically normal heart, in patients with PLSVC, the difficulties and risks of ablation in the vicinity of CS ostium are much higher due to an enlarged CS, which results in a distorted Triangle of Koch and abnormalities of the location of atrioventricular (AV) conduction system. His potential could be recorded at the upper border of CS ostium (as illustrated in the Central Illustration), and ablation in the vicinity of the enlarged CS ostium could induce persistent accelerated junctional rhythm ( 33 ). Therefore, the operator should remain cognizant of the possibility of damaging AV conduction ability during ablation of the CS-PLSVC connection.…”

Section: Discussionmentioning

confidence: 99%

Catheter ablation for atrial fibrillation in patients with persistent left superior vena cava: Case series and systematic review

Gao

Yang

Huang

et al. 2022

Front. Cardiovasc. Med.

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IntroductionPersistent left superior vena cava (PLSVC) is the most common form of thoracic venous abnormality. Catheter ablation (CA) for atrial fibrillation (AF) can be complicated by the existence of PLSVC, which could act as an important arrhythmogenic mechanism in AF.Methods and resultsWe reported a case series of patients with PLSVC who underwent CA for AF at our center between 2018 and 2021. A systematic search was also performed on PubMed, EMBASE, and Web of Science for research reporting CA for AF in patients with PLSVC. Sixteen patients with PLSVC were identified at our center. Ablation targeting PLSVC was performed in 5 patients in the index procedures and in four patients receiving redo procedures. One patient experienced acute procedure failure. After a median follow-up period of 15 months, only 6 (37.5%) patients remained free from AF/atrial tachycardia (AT) after a single procedure. In the systematic review, 11 studies with 167 patients were identified. Based on the included studies, the estimated prevalence of PLSVC in patients undergoing CA for AF was 0.7%. Ablation targeting PLSVC was performed in 121 (74.7%) patients. Major complications in patients with PLSVC receiving AF ablation procedure included four cases of cardiac tamponades (2%), three cases of cardiac effusion (1.5%), one case of ischemic stroke, and three cases of phrenic nerve injury (1.5%) (one left phrenic nerve and two right phrenic nerve). Pooled analysis revealed that after a median follow-up period of 15.6 months (IQR 12.0–74.0 months), the long-term AF/AT-free rate was 70.6% (95% CI 62.8–78.4%, I2 = 0.0%) (Central illustration). Different ablation strategies for PLSVC were summarized and discussed in the systematic review.ConclusionIn patients with PLSVC, recurrence of atrial arrhythmia after CA for AF is relatively common. Ablation aiming for PLSVC isolation is necessitated in most patients. The overall risk of procedural complications was within an acceptable range.

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Section: Discussionmentioning

confidence: 99%

Catheter ablation for atrial fibrillation in patients with persistent left superior vena cava: Case series and systematic review

Gao

Yang

Huang

et al. 2022

Front. Cardiovasc. Med.

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“…[ 5 ] A similar case report of successful ablation of the slow pathway using the anatomical approach was described by Siliste et al . [ 7 ] A left-sided approach targeting the leftward extension of the slow pathway via a transeptal approach may be required in some cases as described by Chokr et al . [ 1 ]…”

Section: Discussionmentioning

confidence: 99%

Ablation of atrioventricular-nodal-reentrant-tachycardia in a patient with left-sided superior vena cava and dilated coronary sinus

Deshpande

Udyavar

2020

Journal of Postgraduate Medicine

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Atrioventricular (AV)-nodal-reentrant-tachycardia is a rare association in a patient with persistent left-sided superior vena cava and dilated coronary sinus. There are a few inherent difficulties in ablation in this condition, viz., difficulty in localization of good site for ablation and difficulty in stabilization of the ablation catheter at the designated site, making it difficult to produce transmural lesions and increasing risk of producing AV block. We hereby present a case highlighting the difficulties and possible solutions for them.

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“…The coexistence of PLSVC and AVNRT is rare and has only been reported in a few case reports [1–5]. In these few cases, the successful ablation sites varied among the significantly dilated ostia of the coronary sinus.…”

Section: Discussionmentioning

confidence: 99%

Three‐dimensional electroanatomical mapping for atrioventricular nodal reentrant tachycardia associated with persistent left superior vena cava

Nakamura

Suzuki

Sugiyama

et al. 2012

Journal of Arrhythmia

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a b s t r a c tBackground: The anatomical courses of the slow pathway and His bundle are altered in patients with atrioventricular nodal reentrant tachycardia (AVNRT) associated with persistent left superior vena cava (PLSVC). We report a case of successful catheter ablation in such a patient using an electroanatomical approach with a three-dimensional mapping system. Case: A 33-year-old woman underwent catheter ablation for AVNRT. The conventional approach for ablating the atrial end of the slow pathway was unsuccessful; therefore, a second attempt was made using a three-dimensional electroanatomical mapping system. The ablation was easily performed without damaging the His bundle because of a clear understanding of the anatomical relationships. Conclusion: The electroanatomical approach using a three-dimensional mapping system can be an alternative if conventional methods prove to be technically difficult because this new approach can provide precise spatial distribution of the pathways.

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Successful slow pathway ablation in a patient with persistent left superior vena cava

Cited by 5 publications

References 3 publications

Catheter ablation for atrial fibrillation in patients with persistent left superior vena cava: Case series and systematic review

Catheter ablation for atrial fibrillation in patients with persistent left superior vena cava: Case series and systematic review

Ablation of atrioventricular-nodal-reentrant-tachycardia in a patient with left-sided superior vena cava and dilated coronary sinus

Three‐dimensional electroanatomical mapping for atrioventricular nodal reentrant tachycardia associated with persistent left superior vena cava

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