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Updated: Jun 6, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Techniques and outcomes of atrial fibrillation ablation in patients with persistent left superior vena cava
Ting-Wei Ernie Liao1, Lingyu Xu1, Mirmilad P Khoshknab1
1Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Insights
Catheter ablation for atrial fibrillation (AF) in patients with a persistent left superior vena cava (PLSVC) presents challenges. Tailored strategies show promise, but recurrence rates remain high, necessitating further research.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Persistent left superior vena cava (PLSVC) complicates atrial fibrillation (AF) ablation due to its arrhythmogenic potential and anatomical variations.
- Understanding these challenges is crucial for optimizing ablation outcomes.
Purpose of the Study:
- To investigate tailored catheter ablation approaches and outcomes in patients with PLSVC undergoing AF ablation.
- To assess the safety and efficacy of these specialized techniques.
Main Methods:
- Retrospective analysis of 16 patients with PLSVC undergoing 21 AF ablation procedures.
- Utilized pre-ablation imaging, 3D electroanatomical mapping, and targeted ablation strategies focusing on PLSVC.
- Primary endpoints included procedural safety and AF recurrence.
Main Results:
- AF triggers from PLSVC identified in 66.7% of procedures.
- Tailored ablation achieved an 85% success rate in isolating PLSVC connections or targeting triggers.
- AF recurrence rates were 46.7% (patient-based) and 65% (procedure-based); no major complications occurred.
Conclusions:
- PLSVC is a significant potential source of AF triggers, requiring specific ablation considerations.
- Current single-procedure success rates are lower than in patients without PLSVC.
- Further research is needed to improve outcomes in this complex patient group.
Objectives:
To investigate tailored approaches, techniques, and outcomes of catheter ablation in patients with persistent left superior vena cava (PLSVC) undergoing atrial fibrillation (AF) ablation.
Background:
PLSVC presents unique challenges for AF ablation due to its potential as an arrhythmogenic source and the complex anatomical variations it introduces.
Methods:
The retrospective cohort included 16 patients with PLSVC that underwent 21 AF ablation procedures between August 1, 2008, and February 14, 2024, at the Hospital of the University of Pennsylvania. Procedures involved pre-ablation imaging, 3D electroanatomical mapping, pulmonary vein isolation, and targeted ablation strategies focusing on the PLSVC-related ablation. The primary endpoints were procedural safety and AF recurrence postablation.
Results:
The cohort's mean age was 51.9 ± 17.9 years, 31.2% of whom were female. Triggers from the PLSVC were identified in 66.7% of procedures. Tailored ablation strategies were employed to isolate PLSVC-left atrium/coronary sinus connections or directly target the induced triggers, with a success rate of 85% in achieving isolation or targeted ablation once triggers were induced. The recurrence rate of arrhythmia postablation was 46.7% in the patient-based analysis and 65% in the procedure-based analysis. No major complications occurred.
Conclusion:
This study highlights the significance of recognizing PLSVC as a potential source of AF triggers. The single procedure success rate is low compared to patients without PLSVC. Further studies are warranted to enhance outcomes in this challenging AF population.
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