Catheter ablation for atrial fibrillation in patients with persistent left superior vena cava: Case series and systematic review
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Updated: Aug 22, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Mingyang Gao1, Yang Bian2, Lihong Huang1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Persistent left superior vena cava (PLSVC) complicates atrial fibrillation ablation. Targeting PLSVC is often necessary, but recurrence rates remain high, though complications are acceptable.
Area of Science:
- Cardiology
- Electrophysiology
- Thoracic Venous Abnormalities
Background:
- Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly.
- PLSVC can complicate catheter ablation (CA) for atrial fibrillation (AF) and may be an arrhythmogenic mechanism.
Purpose of the Study:
- To evaluate the outcomes and complications of catheter ablation for atrial fibrillation in patients with persistent left superior vena cava.
- To determine the prevalence of PLSVC in patients undergoing AF ablation and assess the effectiveness of targeting PLSVC during ablation.
Main Methods:
- A case series of patients with PLSVC undergoing CA for AF was reviewed (2018-2021).
- A systematic literature search was conducted on PubMed, EMBASE, and Web of Science for studies on CA for AF in PLSVC patients.
- Pooled analysis of outcomes, including AF/atrial tachycardia (AT) recurrence and procedural complications, was performed.
Main Results:
- The prevalence of PLSVC in patients undergoing CA for AF was estimated at 0.7%.
- In the case series, 37.5% of patients remained AF/AT-free after a single procedure; long-term AF/AT-free rate in the pooled analysis was 70.6%.
- Major complications included cardiac tamponade (2%), cardiac effusion (1.5%), ischemic stroke (0.6%), and phrenic nerve injury (1.5%).
Conclusions:
- Recurrence of atrial arrhythmia after CA for AF in patients with PLSVC is common.
- Ablation targeting PLSVC isolation is frequently required in these patients.
- The overall risk of procedural complications associated with AF ablation in PLSVC patients is within an acceptable range.
Introduction:
Persistent left superior vena cava (PLSVC) is the most common form of thoracic venous abnormality. Catheter ablation (CA) for atrial fibrillation (AF) can be complicated by the existence of PLSVC, which could act as an important arrhythmogenic mechanism in AF.
Methods And Results:
We reported a case series of patients with PLSVC who underwent CA for AF at our center between 2018 and 2021. A systematic search was also performed on PubMed, EMBASE, and Web of Science for research reporting CA for AF in patients with PLSVC. Sixteen patients with PLSVC were identified at our center. Ablation targeting PLSVC was performed in 5 patients in the index procedures and in four patients receiving redo procedures. One patient experienced acute procedure failure. After a median follow-up period of 15 months, only 6 (37.5%) patients remained free from AF/atrial tachycardia (AT) after a single procedure. In the systematic review, 11 studies with 167 patients were identified. Based on the included studies, the estimated prevalence of PLSVC in patients undergoing CA for AF was 0.7%. Ablation targeting PLSVC was performed in 121 (74.7%) patients. Major complications in patients with PLSVC receiving AF ablation procedure included four cases of cardiac tamponades (2%), three cases of cardiac effusion (1.5%), one case of ischemic stroke, and three cases of phrenic nerve injury (1.5%) (one left phrenic nerve and two right phrenic nerve). Pooled analysis revealed that after a median follow-up period of 15.6 months (IQR 12.0-74.0 months), the long-term AF/AT-free rate was 70.6% (95% CI 62.8-78.4%, I 2 = 0.0%) (Central illustration). Different ablation strategies for PLSVC were summarized and discussed in the systematic review.
Conclusion:
In patients with PLSVC, recurrence of atrial arrhythmia after CA for AF is relatively common. Ablation aiming for PLSVC isolation is necessitated in most patients. The overall risk of procedural complications was within an acceptable range.
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