Arrhythmogenic superior vena cava manifesting after a right‐sided pneumonectomy and mediastinal lymph node dissection

Figures

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  FIGURE 1. (A) Chest X‐ray showing the heart, bronchus, and esophagus, all displaced to the right after the lung cancer surgery. (B, C) Computed tomography scan revealing that the heart was deviated to the right. (D, E) Three‐dimensional reconstructed imaging on computed tomography showing the remnant of the right PV in contact with the SVC. The left PV had a common trunk. Ao, Aorta; CS, coronary sinus; LA, left atrium; LPA, left pulmonary artery; LI(S)PV, left inferior (superior) pulmonary vein; LPV, left pulmonary vein; RA, right atrium; RPAr, remnant of the right pulmonary artery; RPVr, remnant of the right pulmonary vein; SVC, superior vena cava.

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  FIGURE 2. (A, B) Angiography of the RA and SVC. (C, D) Angiography of the LA and RPVr stump. LA, left atrium; LAO, left anterior oblique view; RA, right atrium; RAO, right anterior oblique view; RPVr, remnant of the right pulmonary vein; SVC, superior vena cava.

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  FIGURE 3. (A) A circular mapping catheter was placed in the SVC and a multipolar mapping catheter (Pentaray®, Biosense Webster) was positioned at a remnant of the right PV stump. AF initiation from the SVC (arrows) was identified. (B) The SVC potentials were abolished when the electrical SVC isolation was achieved. (C, D) the catheter position and successful ablation site on fluoroscopy. ABL, ablation catheter; AF, atrial fibrillation; CS, coronary sinus; LAO, left anterior oblique view; RA, right atrium; RAO, right anterior oblique view; RPVr, remnant of the right pulmonary vein; SVC, superior vena cava.