Sinus node injury during adjunctive superior vena cava isolation in a patient with triggered atrial fibrillation

Atrial fibrillation is the most common sustained heart arrhythmia. Premature beats arising from foci other than pulmonary veins have been related to its pathogenesis.

A 64-year-old female underwent superior vena cava (SVC) isolation after triggers were identified originating from the SVC following pulmonary vein isolation; immediately after SVC isolation, she developed junctional rhythm with symptomatic hypotension requiring emergent management. Apical motion abnormalities were noticed in the echocardiography suggesting stress-induced cardiomyopathy which resolved 48 hours later. Although received a dual chamber pacemaker, intact sinus node function returned 2 weeks later.

Superior vena cava isolation in those with trigger mediated atrial fibrillation following pulmonary vein isolation (PVI) is performed to enhance long-term outcomes. Sinus node injury has been related previously to this procedure. We present the first case of time course of recovery of sinus node function, injured during SVC isolation.