Transient chronotropic incompetence owing to sinus node modification after superior vena cava isolation – A rare complication

The superior vena cava (SVC) is the most common non-pulmonary vein trigger for atrial fibrillation (AF). While empiric SVC isolation has not been clearly shown to provide benefit in the treatment of paroxysmal AF, it is appropriate when SVC triggers are demonstrated during AF initiation.1 Furthermore, it is a well-established target for ablation in persistent AF, where non-pulmonary vein triggers are identified in >50% of cases.2 Sinus node injury, usually resulting in both lower resting heart rate (HR) and chronotropic incompetence, is a known complication with a potential major impact on the patients’ quality of life.