Pulsed Field Ablation for Persistent Superior Vena Cava

Figure 1. Fluoroscopic Image of Catheter Positioning during PLSVC Isolation in Case 1 (A) Selective angiography of PLSVC with left anterior oblique (LAO) 40° in Case 1 and the fluoroscopic image of PFA catheters positioned in the proximal PLSVC. (B) The successful elimination of PLSVC potential was achieved at the distal PLSVC on the level between left superior and inferior PVs. PFA = pulsed field ablation; PLSVC = persistent left superior vena cava; PV = pulmonary vein.

Figure 2. Pre- and Post-PLSVC Isolation in Case 1 (A) Fluoroscopic view of a spiral diagnostic catheter positioned in the distal PLSVC with LAO 40°. (B) Intracardiac electrogram showing PLSVC potential before application. (C) Intracardiac electrogram showing the elimination of local PLSVC signals by an application in Case 1. (D) Intracardiac electrogram showing eliminated PLSVC potential after application. (E, F) Comparison of the left atrial voltage maps before (left) and after (right) ablation with the CARTO 3D mapping system with posterior-anterior oblique. Abbreviations as in Figure 1.

Figure 3. Fluoroscopic Image of Catheter Positioning During PLSVC Isolation in Case 2 (A,B) Selective angiographies of PLSVC and left common PV with LAO 40° in Case 2. (C to E) The fluoroscopic images of PFA catheters positioned in the proximal (C), middle (D), and distal (E) PLSVC. The successful elimination of PLSVC potential was obtained with an application at the distal PLSVC on the level of the left common PV. Abbreviations as in Figure 1.

Figure 4. Intracardiac Electrogram Showing the Elimination of Local PLSVC Signals by Application in Case 2