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Left superior vena cava isolation in patients undergoing pulmonary vein antrum isolation: impact on atrial

Claude S Elayi1, Tamer S Fahmy, Oussama M Wazni

  • 1Cleveland Clinic Foundation, Ohio 44195, USA.

Heart Rhythm
|September 2, 2006
PubMed

Insights

Isolating a persistent left superior vena cava (SVC) effectively treated atrial fibrillation (AF) in six patients. This procedure is crucial for preventing AF recurrence when pulmonary veins are not the source.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • A persistent left superior vena cava (SVC) can be an arrhythmogenic source in patients with atrial fibrillation (AF).
  • Connections between the left SVC, coronary sinus (CS), and left atrium (LA) can trigger AF.
  • Clinical data on the impact of left SVC disconnection on AF outcomes are limited.

Purpose of the Study:

  • To assess the impact of left SVC isolation on AF recurrence.
  • To evaluate the efficacy and safety of left SVC isolation in patients with drug-refractory AF and a persistent left SVC.

Main Methods:

  • Six patients with symptomatic drug-refractory AF and persistent left SVC underwent left SVC isolation.
  • Four patients had left SVC isolation as a standalone procedure due to prior unsuccessful pulmonary vein isolation (PVI).
  • Conduction between the left SVC and CS/LA was assessed, and spontaneous ectopies were monitored.

Main Results:

  • Conduction between the left SVC and the CS/LA was documented.
  • Spontaneous ectopies degenerating into AF occurred in one patient.
  • Left SVC isolation was successful in all patients, performed easily (10.25 ± 1.6 minutes) without complications.
  • After 13 ± 7.4 months follow-up, all patients remained in sinus rhythm and free from AF without antiarrhythmic drugs.

Conclusions:

  • Left SVC isolation is a critical step in preventing AF recurrence in selected patients.
  • Identifying and isolating the left SVC is important, especially when pulmonary veins are ruled out as the AF source.
  • Left SVC isolation may be necessary when PVI alone is insufficient to suppress AF.
Abstract

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