Atrial Fibrillation Originating From Persistent Left Superior Vena Cava

Abstract

Background-The left superior vena cava (LSVC) is the embryological precursor of the ligament of Marshall, which has been implicated in the initiation and maintenance of atrial fibrillation (AF). Rarely, the LSVC may persist and has been associated with some organized arrhythmias, though not with AF. We report 5 patients in whom the LSVC was a source of ectopy, initiating AF. Methods and Results-In 5 patients (4 men; age, 46Ϯ11 years) with symptomatic drug-refractory AF, ectopy from the LSVC resulting in AF was observed after pulmonary vein isolation. The ectopics were spontaneous in 2 and induced by isoproterenol in the others and preceded P-wave onset by 67Ϯ13 ms. During multielectrode or electroanatomic mapping, venous potentials were recorded circumferentially at the proximal LSVC near its junction with the coronary sinus (CS), but at the mid-LSVC level, they were recorded only on part of the circumference. The LSVC was electrically connected to the lateral left atrium (LA) and through the CS to the right atrium, with 4.1Ϯ2.3 CS-LSVC and 1.6Ϯ0.5 LA-LSVC connections per patient. Catheter ablation in the LSVC targeting these connections resulted in electrical isolation in 4 of the 5 patients without complications. After 15Ϯ10 months, the 4 patients with successful isolation, including 1 who had successful reablation for LA flutter, remained in sinus rhythm without drugs. Conclusions-The

Pharmacological Tests in Atrial Fibrillation Ablation

“…[69][70][71][72][73][74][81][82][83] Non-PV triggerablation protocols generally involve burst-pacing protocols with isoproterenol infusion to induce the triggers, followed by mapping patients with long-standing persistent AF). 33,84,85 This incidence seems to increase with age, worse atrial substrate and in the presence of cardiomyopathy.…”

“…Most studies considered repetitive premature atrial contraction as the target for ablation. 9,33,[81][82][83][84][85][86][87] Several repetitive premature atrial contractions, however, will never induce AF. As such, an increased success rate has been achieved when targeting only the premature atrial contractions that induce AF.…”

American College of Cardiology, American Heart Association and European Society of Cardiology (2006) Guidelines for the Management of Patients With Atrial Fibrillation

“…Источником ФП чаще все-го являются изменения легочных вен, хотя очаговые из-менения находили также в верхней полой вене, связ-ке Маршалла, задней стенке левого предсердия, по-граничном гребне (crista terminalis) и коронарном си-нусе [37][38][39][40]. При гистологических исследованиях ткань мышцы сердца с неизмененной электрической ак-тивностью обнаруживали в легочных венах [41].…”

Surgical Treatment of Atrial Fibrillation.

“…The Maze procedure includes a complex, bi-atrial lesion set that is applied to all patients having the operation; therefore, it does not include an ablation strategy that is specifically tailored to individual patients [15][16][17][18][19] In the Maze procedure, right and left atrial incisions and cryolesions are constructed to interrupt the multiple, disorganized reentrant circuits that characterize AF (Figure 1). This is termed "cut-and-sew" technique.…”