Provocation and Localization of Arrhythmogenic Triggers from Persistent Left Superior Vena Cava in Patients with Atrial Fibrillation

Figures

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  Figure 1. Diagram Flow Showing Patient Treatments and Procedures. PLSVC, persistent left vena cava; PVI, pulmonary vein isolation.

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  Figure 2. Intracardiac echocardiographic views. (A): Duodecapolar catheter inside the PLSVC from dilated CS. (B): View of the PLSVC after the transseptal puncture. CS, coronary sinus; LA, left atrium; RA, right atrium; PLSVC, persistent left superior vena cava.

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  Figure 3. Fluoroscopic images and computed tomography. (A): Coronary sinus venography performed with a long sheath placed within the dilated coronary sinus (LAO view). * Circular mapping catheter placed in the left inferior pulmonary vein † Circular mapping catheter placed in the PLSVC. (B): Preprocedural CT imaging. anteroposterior view. (C): Posteroanterior view. CS, coronary sinus; PLSVC, persistent left vena cava; LAO, left anterior oblique; SVC, superior vena cava; LA, left atrium; RA, right atrium; CT, computed tomography.

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  Figure 4. Arrhythmogenic trigger from PLSVC. (A): The circular mapping catheters are positioned within the LIPV and PLSVC. During the first two sinus beats, the two components (left atrial far-field and PLSVC potential) are fused. During the ectopic rhythm (the third beat), the sharp potential of the PLSVC precedes the surface ECG by 60 ms. The atrial activation sequence is from distal to proximal on the CS during the PAC. (B): During AF initiation, the sharp potential of the PLSVC precedes the PAC, and the PAC arising from the PLSVC initiates the AF. CS, coronary sinus; PLSVC, persistent left vena cava; LIPV, left inferior pulmonary vein; PAC, premature atrial contraction; AF, atrial fibrillation.

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  Figure 5. Kaplan-Meier Estimates of 3-Year Freedom from Atrial Arrhythmia Recurrence. The recurrence of atrial arrhythmia in both groups after the last ablation procedure is shown. The electrical isolation of PLSVC was determined based on the electrophysiological study for the provocation of arrhythmogenic triggers initiating AF. No significant difference in arrhythmia recurrence was observed between the two groups. PLSVC, persistent left superior vena cava; AF, atrial fibrillation.