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

Higuchi, Koji; Yamauchi, Yasuteru; Hirao, Kazuyuki; Sasaki, Takeshi; Hishida, Hitoshi; Sekiguchi, Yukio; Nitta, Junichi; Isobe, Mitsuaki

doi:10.1016/j.hrthm.2010.05.017

Cited by 82 publications

(69 citation statements)

References 17 publications

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“…24 We speculate that some SVC with long sleeve can serve not only to trigger but also to maintain AF, just as the PV and antrum can. Therefore, high ADFT under IC may be a feature of patients with arrhythmogenic SVC, with long sleeve working as an AF trigger and/or AF maintenance.…”

Section: Discussionmentioning

confidence: 86%

“…In fact, the length of the arrhythmogenic SVC sleeve in the present study (32.9±13.5 mm) would be categorized as long according to the previous study, in which the length of SVC sleeve in arrhythmogenic SVC was 34.7±4.4 mm, whereas that in non-arrhythmogenic SVC was 16.5±11.4 mm. 24 Other Factors Related to ADFT With IC In previous studies, ADFT has been shown to be related to clinical parameters such as AF type, duration, and LA diameter, suggesting an association between ADFT and the extent of atrial remodeling. 10,14, 15 In the present study, we excluded patients with LSAF from the analysis, to better isolate factors affecting ADFT independent of remodeling.…”

Section: Discussionmentioning

confidence: 98%

“…24 Briefly, the SVC sleeve was defined as the segment of SVC in which SVC potentials could be recorded, and the proximal limit of the SVC sleeve (electrical SVC-RA junction) was determined to be where merged SVC and local RA potentials were present. The proximal and distal limits of the sleeve were determined using the circular mapping catheter, after which the length between them was measured utilizing 3-D electroanatomical mapping.…”

Section: Adft and Clinical And Procedural Parametersmentioning

confidence: 99%

“…The SVC is a structure second only to the PV in importance for treating AF. 8, [20][21][22][23][24][25][26] xternal cardioversion (EC) is sometimes used for terminating drug-refractory atrial fibrillation (AF) and is recognized as a useful treatment option for it. 1,2 Internal cardioversion (IC) is an alternative treatment that can be more effective and which delivers lower joule energy than EC.…”

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confidence: 99%

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High Atrial Defibrillation Threshold With Internal Cardioversion Indicates Arrhythmogenicity of Superior Vena Cava in Non-Long-Standing Persistent Atrial Fibrillation

Ihara

Sasaki

Shirai

et al. 2015

Circ J

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Background:The purpose of this study was to clarify the relation between atrial defibrillation threshold (ADFT) for internal cardioversion (IC) and arrhythmogenicity of the superior vena cava (SVC). Methods and Results:A total of 159 consecutive patients (139 male, age 59.9±10.3 years) who underwent radiofrequency catheter ablation of atrial fibrillation (AF) were assessed. IC was performed in 50 patients with non-longstanding persistent AF (non-LSAF) with a purpose-built cardioversion catheter in which direct current is delivered between the right atrium and the coronary sinus. SVC arrhythmogenicity was defined as SVC firing initiating AF, SVC associated with maintenance of AF, or frequent ectopy in the SVC. In all 50 non-LSAF patients, AF termination was obtained on IC during the procedure except in 1 patient with SVC AF. In the patients with ADFT >10 J (n=10), SVC arrhythmogenicity was observed more often than in those with ADFT ≤10 J (n=40; 60% vs. 13%; P=0.004). There were no significant differences between the 2 groups in left atrial diameter (40.8±7.6 vs. 40.6±6.3 mm; P=0.92), persistent AF (33% vs. 50%; P=0.46), or other clinical parameters. The patients who underwent SVC isolation, however, had higher ADFT before SVC isolation than those who did not (15.5±8.8 vs. 9.2±4.4 J; P=0.01). Conclusions:High IC ADFT is associated with SVC arrhythmogenicity in non-LSAF patients. (Circ J 2015; 79: 1479 -1485

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 98%

Section: Adft and Clinical And Procedural Parametersmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

High Atrial Defibrillation Threshold With Internal Cardioversion Indicates Arrhythmogenicity of Superior Vena Cava in Non-Long-Standing Persistent Atrial Fibrillation

Ihara

Sasaki

Shirai

et al. 2015

Circ J

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“…more than 30 mm) sleeves. 9,10 However, the SVC musculature may also be involved in sustaining AF. 11 In a series of 74 patients with SVC-associated AF, Miyazaki et al observed that in the majority of the cases (78.4%), the SVC was found to be a trigger of AF, in that AF originated from the SVC.…”

Section: Introductionmentioning

confidence: 99%

The Role of Superior Vena Cava Isolation in the Management of Atrial Fibrillation

Goyal

Gracia

Fan

2017

JICRM

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ABSTRACT. The superior vena cava (SVC) has been identified as one of the most common sources of non-pulmonary vein triggers for atrial fibrillation (AF). SVC isolation has been shown to improve long-term maintenance of normal sinus rhythm in patients with paroxysmal AF. However, ablation at the SVC is associated with risks of phrenic nerve injury, sinus node dysfunction, and SVC stenosis. The use of electroanatomical mapping, intracardiac echocardiography, compound motor action potentials, and segmental (rather than circumferential) ablation are all strategies to reduce complications. Given these risks, SVC isolation is most effective as an adjunct to pulmonary vein isolation for patients with paroxysmal AF who have been found to have an arrhythmogenic SVC.

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Trigger mapping

Marchlinski¹

2015

Practical Guide to Catheter Ablation of Atrial Fibrillation

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

Cited by 82 publications

References 17 publications

High Atrial Defibrillation Threshold With Internal Cardioversion Indicates Arrhythmogenicity of Superior Vena Cava in Non-Long-Standing Persistent Atrial Fibrillation

High Atrial Defibrillation Threshold With Internal Cardioversion Indicates Arrhythmogenicity of Superior Vena Cava in Non-Long-Standing Persistent Atrial Fibrillation

The Role of Superior Vena Cava Isolation in the Management of Atrial Fibrillation

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