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Superior vena cava flutter: electrophysiology and ablation
Jose L Merino1, Rafael Peinado, Mauricio Abello
1Laboratory of Cardiac Electrophysiology, Hospital La Paz, Universidad Autónoma, Madrid, Spain. jlmerino@secardiologia.es
Journal of Cardiovascular Electrophysiology
|June 11, 2005
Summary
Macroreentry within the superior vena cava (SVC) causes rapid atrial activation. Targeted radiofrequency ablation along the SVC can treat this arrhythmia without fully disconnecting the vein.
Area of Science:
- Electrophysiology
- Cardiology
- Cardiac Arrhythmias
Background:
- Atrial arrhythmias may stem from reentry within major thoracic veins.
- Understanding these reentrant circuits, particularly around the superior vena cava (SVC), is limited.
Observation:
- Atypical atrial flutter was observed in 67 of 225 ablation procedures.
- Three patients exhibited flutter suspected to involve reentry around the SVC.
- Pacing successfully induced and terminated the suspected SVC flutter in all cases.
Findings:
- Macroreentry within the SVC was confirmed through sequential activation and postpacing interval matching.
- Atrial-venous-atrial electrograms were observed following flutter entrainment.
- Radiofrequency ablation targeting the SVC successfully terminated the arrhythmia in all patients.
Implications:
- Macroreentry within the SVC represents a distinct mechanism for rapid atrial activation.
- Longitudinal SVC radiofrequency application offers an effective treatment without complete vein disconnection.