Catheter ablation of atrial fibrillation originating from superior vena cava

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Arrhythmias

Background:

• Atrial fibrillation (AF) originating from the superior vena cava (SVC) is an uncommon cause of arrhythmia.
• Understanding the electrophysiological characteristics of SVC-originating AF is crucial for effective treatment.

Observation:

• A 39-year-old female patient with a history of symptomatic atrial tachycardia and fibrillation presented with rapid firing foci in the anterior SVC.
• Intracardiac mapping identified these foci 2.0 cm above the SVC-right atrium junction, with focal electrograms preceding P waves by 55 msec.

Findings:

• Radiofrequency catheter ablation successfully eliminated the rapid SVC potentials.
• A conduction block between the SVC and atrium was achieved, resolving the arrhythmia.

Implications:

• Muscle sleeves in the SVC can harbor arrhythmogenic foci causing focal atrial fibrillation.
• Radiofrequency catheter ablation offers a curative treatment by isolating the arrhythmogenic SVC.
• This approach provides a potential solution for patients with refractory SVC-originating atrial fibrillation.