Focal atrial tachycardia from the superior vena cava following atrial fibrillation cryoablation: a case report

Figure 1. Electrocardiograms: narrow complex tachyarrhythmia at 90 bpm with variable atrioventricular block and positive P wave in all leads, except aVR (indicated by the blue arrows) (A); and sinus rhythm, with 70 bpm (B).

Figure 2. 3D electroanatomic mapping before (A) and after (B) radiofrequency isolation of the right inferior pulmonary vein. The right inferior pulmonary vein reconnection is indicated by the yellow arrow. LIPV, left inferior pulmonary vein; RSPV, right superior pulmonary vein; LA, left atrium; LSPV, left superior pulmonary vein.

Figure 3. Electrophysiological study with 3D electroanatomical mapping: (A) local signals at the level of the superior wall of the RA, near the SVC (blue arrows); (B) fragmented electrograms at the level of the posterior wall of the SVC (blue arrows); (C,D) atrial tachycardia localization: 3D electroanatomical activation mapping demonstrating the earliest site of activation within the SVC (red area, indicated by the orange arrow) and location of radiofrequency applications (pink points, indicated by the blue arrow) that led to the termination of atrial tachycardia; (E) 3D ultrahigh-density electroanatomic mapping with Optrell multipolar catheter revealing a relatively large low-voltage area at the level of the superior and posterior wall of the RA–superior vena cava junction that mirrors the contact area with right superior pulmonary vein; and (F) fragmented electrograms in the same area. RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein; LA, left atrium; LSPV, left superior pulmonary vein; SVC, superior vena cava.

Figure 4. Summary of the clinical course of the patient, including index cryoballoon ablation, recurrence, repeat electrophysiological study, and follow-up.