Visualization of persistent superior vena cava isolation by cryoballoon ablation

A 54-year-old man with paroxysmal atrial fibrillation underwent pulmonary vein (PV) isolation using a 28-mm second-generation cryoballoon catheter. Unexpected electrical superior vena cava (SVC) isolation during cryoballoon application to the right superior PV was observed in the first procedure. Thirteen-months after cryoballoon-based PV isolation, sustained SVC fibrillation was confirmed irrespective of sinus rhythm. Voltage mapping visualized a low voltage area around the SVC was close to that around the right superior PV. SVC isolation was obtained by cryoballoon application to the right superior PV and persisted for over a year. <Learning objective: Simultaneous superior vena cava (SVC) isolation during cryoballoon application to the right superior pulmonary vein (RSPV) was previously reported in the acute phase. However, the long-term impact of simultaneous RSPV-SVC isolation is undetermined. Here we describe a case of persistent SVC isolation by cryoballoon-based PV isolation. The three-dimensional imaging visualized a small anatomical distance between the RSPV-SVC and the persistent effect of the cryoballoon application to the SVC.>.