Focal ablation for atrial fibrillation originating from the inferior vena cava and the posterior left atrium

Mizobuchi, Masahiro; Enjoji, Yoshihisa; Shibata, Kensaku; Funatsu, Atsushi; Yokouchi, Itaru; Kambayashi, Daisuke; Kobayashi, Tomoko; Nakamura, Shigeru

doi:10.1007/s10840-006-9037-1

Cited by 8 publications

(8 citation statements)

References 11 publications

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“…They demonstrated that the cardiac muscle fibers in the IVC were more plentiful in the anterior aspect than in the posterior aspect. Interestingly, in our case and most of the previous cases (5,6,8,9) in which AF originated in the IVC, The precordial 6 lead rhythm strip shows termination of atrial flutter with a sinus beat (red asterisk), followed by four consecutive ectopic atrial beats at rate 250/min, which showed a narrow positive wave in lead V1 (red arrow). The first conducted beat occurred with the right brunch block, the second was blocked, the third conducted a with a narrow QRS, and the fourth was blocked.…”

Section: Discussionsupporting

confidence: 56%

“…The IVC ablation schemes were not consistent among the past five case reports. In two cases (5,8), focal ablation (like in our case) was chosen; in one case (6), IVC isolation was selected; and in two cases (7,9), radiofrequency was applied in addition to target ablation, consequently achieving IVC isolation. All of the above patients were free of AF during the follow-up without complications.…”

Section: Discussionmentioning

confidence: 99%

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Paroxysmal Atrial Fibrillation Originating From the Inferior Vena Cava: A Case Report and Literature Review

Tao

Yang

Chen

2022

Front. Cardiovasc. Med.

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Atrial fibrillation is a common arrhythmia, but atrial fibrillation originating in the inferior vena cava is extremely rare. Here, we present a case of a 51-year-old woman with symptomatic paroxysmal atrial fibrillation, who was admitted to the Second Affiliated Hospital of Dalian Medical University and underwent radiofrequency ablation. The atrial fibrillation persisted despite pulmonary vein isolation. The inferior vena cava was then identified not only as a trigger but also as the driver to maintain atrial fibrillation, and tachycardia terminated successfully by discharging at the inferior vena cava. Furthermore, we performed a literature review of five previous case reports on this subject.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Paroxysmal Atrial Fibrillation Originating From the Inferior Vena Cava: A Case Report and Literature Review

Tao

Yang

Chen

2022

Front. Cardiovasc. Med.

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“…AF originating from IVC is extremely rare in clinical practice due to the absence of the myocardial sleeve in human IVC (24)(25)(26)(27); nevertheless, we also identified a similar short ERP in the sheep IVC myocardial sleeve. The difference in arrhythmogenesis between the IVC and other thoracic veins is suggested to result from the embryonic developmental process.…”

Section: Discussionsupporting

confidence: 49%

Refractoriness of the Sheep Superior Vena Cava Myocardial Sleeve

Zhao

Liu

et al. 2008

Exp Biol Med (Maywood)

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The cardiomyocytes in the superior vena cava (SVC) myocardial sleeve have distinct action potentials and ionic current profiles, but the refractoriness of these cells has not been reported. Using standard intracellular microelectrode techniques, we demonstrated in sheep that the effective refractory period (ERP) of the cardiomyocytes in the SVC (114.7 +/- 6.5 ms) is shorter than that in the inferior vena cava (IVC) (166.7 +/- 6.2 ms), right atrial free wall (RAFW) (201.0 +/- 6.0 ms) and right atrial appendage (RAA) (203.1 +/- 5.8 ms) (P < 0.05). The right atrial cardiomyocyte ERP was heterogeneously shortened by acetylcholine, a muscarinic type 2 receptor (M(2)R) agonist. After perfusion with 15 microM acetylcholine, the shortest ERP occurred in the SVC (the ERP in the SVC, IVC, RAFW and RAA was 53.6 +/- 2.7, 98.9 +/- 2.2, 121.8 +/- 6.0 and 109.7 +/- 5.1 ms, respectively; P < 0.05). Carbachol (1 microM), another M(2)R agonist, produced a similar effect as acetylcholine. Furthermore, we used methoctramine, a M(2)R blocker, 4-DAMP, a muscarinic type 3 receptor (M(3)R) blocker, and tropicamide, a muscarinic type 4 receptor (M(4)R) blocker to inhibit the acetylcholine-induced ERP shortening of SVC cardiomyocytes, and found that the 50% inhibitory concentration for methoctramine, 4-DAMP and tropicamide was 5.91, 45.72 and 80.34 nM, respectively. Therefore, we conclude that the sheep SVC myocardial sleeve is a unique electrophysiological region of the right atrium with the shortest ERP both under physiological condition and under cholinergic agonist stimulation. M(2)R might play a major role in the response of the SVC myocardial sleeve to parasympathetic nerve tone. The association between the distinct refractoriness in SVC and atrial fibrillation originating from the region deserves further investigation.

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“…The IVC has been reported as a non-PV trigger site in few case reports. 31 Since atrialization of the IVC is limited, triggers from this structure will be rare. Triggers from the IVC presents P-wave morphology and intracardiac activation sequence similar to inferolateral CT ectopies; therefore, direct recording from the IVC is crucial to establish the definitive site of origin.…”

Section: Ivcmentioning

confidence: 99%

Techniques for the provocation, localization, and ablation of non–pulmonary vein triggers for atrial fibrillation

2017

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The end point of current catheter-based ablation approaches for the treatment of atrial fibrillation (AF) is the elimination of all the possible triggers with the least amount of ablation necessary. Once all the triggers have been eliminated, the incremental value of any additional lesion sets remains to be proven. Pulmonary vein (PV) isolation is the cornerstone of catheter ablation approaches for eliminating AF triggers. However, up to 11% of patients demonstrate reproducible sustained AF initiation from non-PV foci. In these patients, triggers can typically be elicited using standardized induction protocols, which include cardioversion of spontaneous and/or induced AF and infusion of high-dose isoproterenol. Non-PV triggers typically arise from discrete anatomical structures that include the mitral and tricuspid periannular regions, the crista terminalis and Eustachian ridge, the interatrial septum, the left atrial (LA) posterior wall, the left atrial appendage (LAA), and other thoracic veins such as the superior vena cava, the coronary sinus, and the ligament of Marshall. Localization of non-PV foci involves a detailed analysis of specific intra-atrial activation sequences using multipolar catheters in standard atrial locations coupled with information from the surface electrocardiogram P wave when possible. Multipolar catheters positioned along the coronary sinus and crista terminalis/superior vena cava region together with direct recordings from the right and left PVs allow a quick localization of non-PV foci. Elimination of non-PV triggers by means of focal ablation at the site of origin or isolation of arrhythmogenic structures (eg, LA posterior wall or superior vena cava) has been associated with improved arrhythmia-free survival.

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Focal ablation for atrial fibrillation originating from the inferior vena cava and the posterior left atrium

Cited by 8 publications

References 11 publications

Paroxysmal Atrial Fibrillation Originating From the Inferior Vena Cava: A Case Report and Literature Review

Paroxysmal Atrial Fibrillation Originating From the Inferior Vena Cava: A Case Report and Literature Review

Refractoriness of the Sheep Superior Vena Cava Myocardial Sleeve

Techniques for the provocation, localization, and ablation of non–pulmonary vein triggers for atrial fibrillation

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