Pulsed-Field Ablation Circular Catheter Use in Left Superior Vena Cava–Associated Atrial Arrhythmias

Figures

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  Figure 1. Clinical Presentation and Anatomical Landmarks The preoperative CTA identified a PLSVC communicating with the left atrium via the coronary sinus (CS) (A and B); the pulmonary veins exhibited no anatomical abnormalities (C). AO = aorta; AS = aortic stenosis; CS = coronary sinus; CTA = computed tomography angiography; LA = left atria; LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; PLSVC = persistent left superior vena cava; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein.

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  Figure 2. Anatomical Mapping and Pulsed-Field Ablation Applications to Left Atrium The pulmonary vein and PLSVC models were manually constructed using ICE (A and B); bilateral PVI was performed using a standard protocol (C); left atrial roof ablation, posterior wall “BOX” ablation, and mitral isthmus ablation were also conducted (D); post ablation, the patient's rhythm converted to atrial tachycardia (E). ICE = intracardiac echocardiography; PLSVC = persistent left superior vena cava; PVI = pulmonary vein isolation.

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  Figure 3. Pulsed-Field Ablation Applications to Isolate PLSVC The activation mapping of the PLSVC using the VLCC indicates that the initial activation occurs in the mid-portion (A). PFA at this site successfully terminates tachycardia and restores sinus rhythm (B and C). Postprocedural verification confirms isolation of the bilateral pulmonary veins and posterior wall, as well as blockage of the mitral isthmus (D). PFA = pulsed-field ablation; PLSVC = persistent left superior vena cava; VLCC = variable-loop circular catheter.

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  Visual Summary. Steps for Ablating the Persistent Left Superior Vena Cava–Associated Atrial Arrhythmia Using the “Varipulse” Pulsed-Field Ablation System