This Article Full Text Full Text (PDF) All Versions of this Article: 109/7/828    most recent 01.CIR.0000116753.56467.BCv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hsu, L.-F. Articles by Haïssaguerre, M. Search for Related Content PubMed PubMed Citation Articles by Hsu, L.-F. Articles by Haïssaguerre, M. Related Collections Ablation/ICD/surgery Arrhythmias, clinical electrophysiology, drugs

(Circulation. 2004;109:828-832.)
© 2004 American Heart Association, Inc.

Brief Rapid Communications

Atrial Fibrillation Originating From Persistent Left Superior Vena Cava

Li-Fern Hsu, MBBS; Pierre Jaïs, MD; David Keane, MD; J. Marcus Wharton, MD; Isabel Deisenhofer, MD; Mélèze Hocini, MD; Dipen C. Shah, MD; Prashanthan Sanders, MBBS, PhD; Christophe Scavée, MD; Rukshen Weerasooriya, MBBS; Jacques Clémenty, MD; Michel Haïssaguerre, MD

From Hôpital Cardiologique du Haut-Lévèque, Bordeaux-Pessac, France (L.-F.H., P.J., I.D., M.H., D.C.S., P.S., C.S., R.W., J.C., M.H.); Massachusetts General Hospital (D.K.), Boston, Mass; and Medical University of South Carolina (J.M.W.), Charleston, SC.

Correspondence to Dr Li-Fern Hsu, Hopital Cardiologique du Haut-Lévèque, Avenue de Magellan, 33604 Bordeaux-Pessac, France. E-mail hsulifern{at}yahoo.com.sg

Received June 16, 2003; de novo received October 13, 2003; revision received December 15, 2003; accepted December 22, 2003.

Background— The left superior vena cava (LSVC) is the embryological precursor of the ligament of Marshall, which has been implicated in the initiation and maintenance of atrial fibrillation (AF). Rarely, the LSVC may persist and has been associated with some organized arrhythmias, though not with AF. We report 5 patients in whom the LSVC was a source of ectopy, initiating AF.

Methods and Results— In 5 patients (4 men; age, 46±11 years) with symptomatic drug-refractory AF, ectopy from the LSVC resulting in AF was observed after pulmonary vein isolation. The ectopics were spontaneous in 2 and induced by isoproterenol in the others and preceded P-wave onset by 67±13 ms. During multielectrode or electroanatomic mapping, venous potentials were recorded circumferentially at the proximal LSVC near its junction with the coronary sinus (CS), but at the mid-LSVC level, they were recorded only on part of the circumference. The LSVC was electrically connected to the lateral left atrium (LA) and through the CS to the right atrium, with 4.1±2.3 CS-LSVC and 1.6±0.5 LA-LSVC connections per patient. Catheter ablation in the LSVC targeting these connections resulted in electrical isolation in 4 of the 5 patients without complications. After 15±10 months, the 4 patients with successful isolation, including 1 who had successful reablation for LA flutter, remained in sinus rhythm without drugs.

Conclusions— The LSVC can be the arrhythmogenic source of AF with connections to the CS and LA. Ablation of these connections resulted in electrical isolation.

Key Words: catheter ablation • fibrillation • mapping

This article has been cited by other articles:

				F. Regoli, S. Raffa, A. Grosse, M. Brunelli, and J. C. Geller Left superior vena cava conduction to the left atrium unmasked by adenosine in a patient with paroxysmal atrial fibrillation during pulmonary vein isolation Europace, October 31, 2009; (2009) eup325v1. [Abstract] [Full Text] [PDF]

				P. De Filippo, S. Colombo, R. Brambilla, A. Borghi, and F. Cantu Ablation of Atrial Tachycardia From a Giant Left Superior Vena Cava Using Integration With Computed Tomographic Imaging Circ Arrhythm Electrophysiol, June 1, 2008; 1(2): 143 - 144. [Full Text] [PDF]

				D. Guerrot, M. Hanoy, and M. Godin Haemodialysis catheterization via type II persistent left superior vena cava NDT Plus, April 1, 2008; 1(2): 100 - 102. [Full Text] [PDF]

				S. Bhatti, A. Hakeem, U. Ahmad, M. Malik, P. Kosolcharoen, and Su Min Chang Persistent left superior vena cava (PLSVC) with anomalous left hepatic vein drainage into the right atrium: role of imaging and clinical relevance Vascular Medicine, November 1, 2007; 12(4): 319 - 324. [Abstract] [PDF]

				F. Saremi and S. Krishnan Cardiac Conduction System: Anatomic Landmarks Relevant to Interventional Electrophysiologic Techniques Demonstrated with 64-Detector CT RadioGraphics, November 1, 2007; 27(6): 1539 - 1565. [Abstract] [Full Text] [PDF]

				H. Liu, K.-T. Lim, C. Murray, and R. Weerasooriya Electrogram-guided isolation of the left superior vena cava for treatment of atrial fibrillation Europace, September 1, 2007; 9(9): 775 - 780. [Abstract] [Full Text] [PDF]

				W. Schummer, C. Schummer, and S. G. Sakka A Persistent Left Superior Vena Cava: Erroneous Measurement of Cardiac Output Anesth. Analg., November 1, 2006; 103(5): 1340 - 1341. [Full Text] [PDF]

				Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 651 - 745. [Full Text] [PDF]

				V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society J. Am. Coll. Cardiol., August 15, 2006; 48(4): 854 - 906. [Full Text] [PDF]

				V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society J. Am. Coll. Cardiol., August 15, 2006; 48(4): e149 - e246. [Full Text] [PDF]

				V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society Circulation, August 15, 2006; 114(7): e257 - e354. [Full Text] [PDF]

				V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society Circulation, August 15, 2006; 114(7): 700 - 752. [Full Text] [PDF]

				Authors/Task Force Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Eur. Heart J., August 2, 2006; 27(16): 1979 - 2030. [Full Text] [PDF]

				T. Deneke, K. Khargi, K.-M. Muller, B. Lemke, A. Mugge, A. Laczkovics, A. E. Becker, and P. H. Grewe Histopathology of intraoperatively induced linear radiofrequency ablation lesions in patients with chronic atrial fibrillation Eur. Heart J., September 1, 2005; 26(17): 1797 - 1803. [Abstract] [Full Text] [PDF]