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March 31, 2026HeartRhythm Case ReportsOpen Access

A case of superior vena cava reentrant atrial tachycardia after pulmonary vein isolation with pentaspline pulsed field ablation

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Population

1 adult with heart failure owing to persistent atrial fibrillation, with initially reduced LVEF that…

Design

Case_report

Follow-up

3 months

Discussion

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Overview

May signal unintended SVC reentry after distal RSPV PFA; leaves open its incidence and prevention.

Structured PICO

P
Population
1 adult (57-year-old man) with heart failure owing to persistent atrial fibrillation, with initially reduced LVEF (30%) that improved to 60% after cardioversion.
I
Intervention
Pulmonary vein isolation using a pentaspline pulsed field ablation catheter (FARAPULSE) with 61 applications, including an olive-shaped configuration at the right superior pulmonary vein, plus empirical cavotricuspid isthmus radiofrequency ablation.
O
Outcome
Development of superior vena cava reentrant atrial tachycardia.

Pulsed field ablation at the distal right superior pulmonary vein may unintentionally affect the superior vena cava, potentially creating a substrate for reentrant atrial tachycardia.

Limitations

  • Preexisting low-voltage substrate cannot be completely excluded because right atrium and superior vena cava voltage mapping was not performed before pulsed field ablation at the initial procedure.
  • Considerations regarding the mechanism remain speculative and require future studies.

Cite This Study

A 2026 study studied this question.

synapsesocial.com/papers/6a025cd7edf6f48138594a51https://doi.org/10.1016/j.hrcr.2026.03.016
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Superior Vena Cava as an Arrhythmogenic Substrate in Atrial Fibrillation: Anatomical, Electrophysiological and Clinical Perspectives2025 · 5 citations
  2. 2Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation2023 · 961 citations
  3. 3Characterization of Complex Atrial Tachycardia in Patients With Previous Atrial Interventions Using High-Resolution Mapping2020 · 63 citations
  4. 4Incidence and Characteristics of Superior Vena Cava Impact After Pulsed‐Field Ablation of the Right Pulmonary Veins2025 · 10 citations
  5. 5Pulmonary Vein Isolation vs Sham Intervention in Symptomatic Atrial Fibrillation2024 · 57 citations