Does pulsed field ablation safely isolate arrhythmogenic PLSVC and restore performance in an endurance athlete with persistent AF?
Pulsed field ablation can safely and effectively isolate non-pulmonary vein triggers like a persistent left superior vena cava in athletes with recurrent atrial fibrillation.
BACKGROUND: Masters endurance athletes have an elevated risk of atrial fibrillation (AF) due to atrial remodeling, autonomic shifts, and long-term training loads. Management is challenging when persistent AF limits performance despite guideline-directed care. CASE SUMMARY: A 60-year-old lifelong swimmer and cyclist with persistent AF experienced a 20% to 25% decline in exercise performance. AF recurred shortly after pulmonary vein isolation, and antiarrhythmic drugs were ineffective or poorly tolerated. A known persistent left superior vena cava (PLSVC) suggested a non-pulmonary vein trigger. Repeat ablation with pulsed field ablation successfully isolated the PLSVC without complications. Follow-up demonstrated restored exercise capacity and no sustained AF recurrence. DISCUSSION: This case highlights the role of non-pulmonary vein triggers in athletes and the potential safety advantages of pulsed field ablation for complex anatomical targets. TAKE-HOME MESSAGE: Pulsed field ablation may safely isolate arrhythmogenic PLSVC and restore performance in endurance athletes.
Mi et al. (Fri,) studied this question.