Visualization of the electrophysiologically defined junction between the superior vena cava and right atrium

Abstract

IntroductionAn electrical superior vena cava (SVC) isolation from the right atrium (RA) sometimes can be challenging. For a safe and efficient SVC isolation, we aimed to visualize the accurate position of the SVC‐RA junction on a three‐dimensional (3D) mapping system using the decremental conduction properties of the SVC‐RA junction in patients with atrial fibrillation (AF).MethodsThis study consisted of 15 consecutive AF patients (11 males, age 59 ± 10 years). A 3D mapping catheter was positioned in the SVC‐RA junction region while delivering a single extra‐stimulus from the right atrial appendage (RAA), to discriminate the RA and SVC potentials. The electrophysiological SVC‐RA junction was defined as the most proximal points where the SVC potentials were recorded, which were tagged on the 3D mapping system around the SVC‐RA junction, where radiofrequency energy applications were applied.ResultsAround the SVC‐RA junction, 9 ± 2 points were tagged on the 3D mapping system. The highest and lowest SVC‐RA junction points were located on the anterior wall and posterior wall, respectively. The difference in the level between the highest and lowest SVC‐RA junction points was 16.2 ± 6.3 mm. A successful SVC isolation was obtained in all patients without any complications.ConclusionThe plane of the electrophysiologically defined SVC‐RA junction was not perpendicular to the body axis, but slanted due to the anterior side being higher. Recognizing the precise location of the SVC‐RA junction would contribute to a safe and efficacious SVC isolation.

Efficacy, Safety and Feasibility of Superior Vena Cava Isolation in Patients Undergoing Atrial Fibrillation Catheter Ablation: An Up-to-Date Review

“…A mean number of 9.3 ± 2.0 points were needed, and anterior SVC segment points were higher than posterior points. Three-dimensional maps of phrenic nerve capture were also constructed in 11/15 patients and the following SVC walls were involved in a decreasing order of frequency lateral, posterolateral and posterior [ 48 ].…”

Radiofrequency ablation-induced superior vena cava stenosis in a 5-year-old boy with congenital left atrial appendage deformity: a case report and literature review

“…Height distribution involves three locations: the SVC, right atrium, and SVC-right atrial junction. The sinoatrial node is considered to be in the right atrium when its height is two-thirds lower than the SVC-right atrial junction, and in the SVC when its height is two-thirds higher than the SVC-right atrial junction ( 21 ). Plane distribution is described by the head and foot position, 1–3 o’clock position corresponds to the postero-septal position, 3–5 o’clock to the antero-septal position, 5–7 to the anterior position, 7–9 o’clock to the anterolateral position, 9–11 o’clock to the posterolateral position, and 11–1 o’clock to the posterior position ( Figure 4 ).…”

A novel approach for effective superior vena cava isolation using the CARTO electroanatomical mapping system

“…Here, the RA‐SVC conduction block was higher in the anterior portion than in the posterior portion, and atrial activation from the sinus node was conducted in a superior and clockwise direction as described in previous papers. 12 , 13 , 14 …”