Pulsed Field Ablation Terminated Atrial Fibrillation Triggered by Persistent Left Superior Vena Cava: A Case Report

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Recurrent atrial fibrillation (AF) after ablation poses a clinical challenge.
• Persistent left superior vena cava (PLSVC) is an anatomical variation that can complicate AF ablation.
• Previous ablation procedures may not fully address complex arrhythmogenic substrates.

Purpose of the Study:

• To evaluate the efficacy of Pulsed Field Ablation (PFA) for treating recurrent AF in a patient with PLSVC.
• To demonstrate the utility of a circular array PFA catheter in ablating within the PLSVC.
• To assess PFA's ability to target arrhythmogenic sources in challenging anatomies.

Main Methods:

• A 73-year-old patient with paroxysmal AF and prior ablations underwent re-intervention.
• Preprocedural imaging (echocardiography, CT) identified a persistent left superior vena cava (PLSVC).
• A circular array Pulsed Field Ablation (PFA) catheter was utilized for the ablation procedure.

Main Results:

• Incessant AF was induced during the procedure.
• PFA successfully terminated AF originating from the distal part of the PLSVC.
• High-frequency fragmented electrograms were identified within the PLSVC, guiding ablation.

Conclusions:

• Circular array PFA is effective for treating AF in the presence of PLSVC.
• PFA offers a viable option for complex AF re-interventions in challenging venous anatomies.
• Targeted PFA ablation within the PLSVC can successfully eliminate arrhythmogenic sources.