Superior Vena Cava Flutter: Electrophysiology and Ablation

Merino, José Luís; Peinado, Rafaél; Abello, Maurício; Gnoatto, Mariana; Vasserot, Mar González; Sobrino, José A.

doi:10.1046/j.1540-8167.2005.40609.x

Cited by 16 publications

(14 citation statements)

References 23 publications

(25 reference statements)

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“…SVC cadiomyocytes can depolarize spontaneously [8,9], and ectopic firings from the SVC could initiate and maintain AT and AF [1][2][3][4]. In addition to automaticity, reentry within the SVC has also been reported to be one of the involved mechanisms [2,11]. In the present case, the rhythm in the SVC locally exhibited AF, and we considered this to be the cause of the AT.…”

Section: Discussionmentioning

confidence: 56%

Atrial tachycardia caused by a superior vena cava fibrillation with conduction block

Nozoe

Koyama

Honda

et al. 2012

Journal of Arrhythmia

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a b s t r a c tAT caused by SVC fibrillation: Here, we report a case of a 62-year-old man with a history of incessant atrial tachycardia (AT) for several years. An electrophysiological study revealed rapid and irregular activity in the superior vena cava (SVC), but the surface 12-lead electrocardiogram (ECG) exhibited a relatively regular AT (atrial cycle length ¼ 240 ms). CARTO mapping of the right atrium (RA) demonstrated that the earliest atrial activation occurred at the posterior septum of the upper RA (the SVC-RA junction). Intravenous administration of 20 mg adenosine triphosphate (ATP) led to an acceleration of the SVC-RA conduction up to 1:1 conduction, and the atrial cycle length decreased, consequently converting the AT to transient atrial fibrillation (AF). Application of single radiofrequency energy at the earliest atrial activation site during tachycardia terminated the AT and achieved isolation of the SVC from the RA, despite the continued presence of fibrillation in the SVC. We speculated that SVC fibrillation with spontaneous conduction block at the SVC-RA junction was the cause of this AT.

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Section: Discussionmentioning

confidence: 56%

Atrial tachycardia caused by a superior vena cava fibrillation with conduction block

Nozoe

Koyama

Honda

et al. 2012

Journal of Arrhythmia

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“…3,46 In addition, macroreentry in the SVC may induce atypical atrial flutter. 47 Compared with the PVs, SVC ectopy has a higher incidence of intravenous conduction block and a shorter interval preceding ectopic P waves. 3 Moreover, the left SVC (the embryological precursor of the LOM) can also be the arrhythmogenic source of AF.…”

Section: Svc Arrhythmiamentioning

confidence: 99%

Thoracic Vein Arrhythmias

Chen

2007

Circ J

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The thoracic veins are important foci for the genesis of ectopic atrial tachycardia and play a critical role in the pathophysiology of paroxysmal and permanent atrial fibrillation. The pulmonary veins have the highest arrhythmogenic activity and other venous structures (eg, superior vena cava, coronary sinus and ligament of Marshall) have also been shown arrhythmogenic potential. Thoracic veins contain cardiomyocytes with distinct electrical activities and complex anatomical structures. This review summaries the current understanding of the basic and clinical electrophysiology of thoracic vein arrhythmias. (Circ J 2007; Suppl A: A-20 -A-25)

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“…However, documentation of atrial activation though the complete LAT cycle length is insufficient evidence to establish a reentrant mechanism, especially when the LAT cycle length is short or the time to complete LA activation is prolonged as a consequence of conduction block created by multiple radiofrequency applications. The unequivocal proof of reentry, leaving aside some theoretical possibilities that are more of academic than clinical interest, is the demonstration of fusion during entrainment or, what is even more compelling, PPIs matching the tachycardia cycle length following entrainment by pacing from different circuit sites 11,20 . However, responses to LAT entrainment were not systematically analyzed in most of these studies.…”

Section: Editorial Commentmentioning

confidence: 99%

“…Increase of circuit size and tachycardia cycle length has been reported following linear RF application within a thoracic vein. 20 …”

Section: Pathogenesis Of Reentrant Left Atrial Tachycardiamentioning

confidence: 99%

“…1). This latter possibility cannot be discarded because complex interrelation between concurrent and alternating reentrant circuits, some of them within a thoracic vein, have recently been reported 20 . This hypothesis may also explain why recently reported approaches for AF ablation, which are based on radiofrequency application on atrial sites displaying complex fragmentation, a typical sign of slow conduction, demonstrate a high success rate 30 .…”

Section: Relation Between Left Atrial Tachycardias and Atrial Fibrillmentioning

confidence: 99%

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Superior Vena Cava Flutter: Electrophysiology and Ablation

Cited by 16 publications

References 23 publications

Atrial tachycardia caused by a superior vena cava fibrillation with conduction block

Atrial tachycardia caused by a superior vena cava fibrillation with conduction block

Thoracic Vein Arrhythmias

Slow Conduction and Flutter Following Atrial Fibrillation Ablation: Proarrhythmia or Unmasking Effect of RadiofrequencyApplication?

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