Abstract 2101: Left Superior Vena Cava Isolation In Patients Undergoing Pulmonary Vein Antrum Isolation: Impact On Atrial Fibrillation Recurrence
BACKGROUND: A persistent left superior vena cava (LSVC) can be an arrhythmogenic source in patients with atrial fibrillation (AF) through connections from the coronary sinus (CS) and the left atrium (LA). The LSVC can be electrically isolated. However, there is little clinical data about the impact of LSVC disconnection on AF outcome. We report on six patients with LSVC and recurrent AF.
OBJECTIVE: The purpose of this study was to assess the impact of LSVC isolation on AF recurrence.
METHODS AND RESULTS: Six patients (4 men; age 50±6.4 years) with symptomatic drug-refractory AF and with a persistent LSVC presented to our lab for treatment; four of the patients had LSVC isolation only because there was no conduction recovery in the pulmonary veins (PVs) after several previous procedures. Conduction between the LSVC and the CS and LA was documented as well as spontaneous ectopies in 3 patients that degenerate into AF in one patient. Isolation of the LSVC was successful in all patients. Isolation was relatively easy to perform (10.25±1.6 minutes) with no complications. After a 13±7.4 months follow-up, all patients were in sinus rhythm and free from atrial fibrillation without antiarrhythmics drugs.
CONCLUSIONS: This study stresses the importance of looking for unusual sources of AF in patients presenting for repeat procedures or in those that the PVs have been ruled out as a source triggering AF. We present clinical evidence that in patients with AF and LSVC, isolation of the PVs only may not be enough to suppress AF. Thus, diagnosis and isolation of the LSVC appears critical to avoid AF recurrence in patients with AF when ablation is considered.