Key result
Cryoballoon ablation of the right superior pulmonary vein revealed a near-field signal preceding pulmonary vein activation, interpreted as a superior vena cava potential.
Case Report (n=1)
This case highlights the risk of inadvertent superior vena cava isolation when targeting the right superior pulmonary vein during cryoballoon ablation.
Inadvertent SVC isolation risks RSPV cryoballoon ablation; case report leaves open optimal mapping strategies.
A 36-year-old man was referred for pulmonary vein (PV) isolation because of paroxysmal atrial fibrillation. PV isolation was performed with a 28 mm cryoballoon (Medtronic, Minneapolis, MN). Following the isolation of the left and right inferior PVs, the right superior PV (RSPV) was targeted. Before the application, a late sharp potential (P1) thought to represent PV activation was observed on the circular decapolar mapping catheter (Achieve™; Medtronic) (Figure 1A). P1 was preceded by a near-field signal (P2), which was simultaneous with the first half of the P wave and was interpreted as a superior vena cava (SVC) potential.
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Bergonti et al. (2022) conducted a case report in paroxysmal atrial fibrillation (n=1). Pulmonary vein isolation with a 28 mm cryoballoon was evaluated. Cryoballoon ablation of the right superior pulmonary vein revealed a near-field signal preceding pulmonary vein activation, interpreted as a superior vena cava potential.
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