Pulsed field ablation in persistent left superior vena cava for atrial fibrillation via interrupted inferior vena cava with azygos continuation utilizing novel electroanatomic mapping features in the presence of a permanent pacemaker

Figures

• 

  Figure 1. A, B: Anterior-posterior fluoroscopy projections demonstrating contrast injection through the SR0 sheath (yellow arrows) within the azygos continuation. C: Anterior (left) and posterior (right) projection voltage maps of the SVC, right atrium, CS, and PLSVC. His bundle recordings are marked by yellow dots. PLSVC potentials (red arrow) are seen on the Advisor HD Grid Mapping Catheter near the PLSVC-CS junction within the low-voltage zone. CS = coronary sinus; PLSVC = persistent left superior vena cava; SVC = superior vena cava.

• 

  Figure 2. Pulsed field ablation within PLSVC using azygos continuation into the right SVC. A: Basket configuration with Contact Index threshold set at 9% visualized on the full electroanatomic map (left) and zoomed (right). All splines were 9% or greater and colored blue. B: Anterior-posterior fluoroscopy projection in basket configuration. C: Anterior-posterior fluoroscopy projection in flower configuration. CS = coronary sinus; PLSVC = persistent left superior vena cava; SVC = superior vena cava.

• 

  Figure 3. A: Pulsed field ablation applications resulted in oversensing, pacemaker suppression, and a 3.6-second episode of asystole. B: Postablation voltage maps demonstrated isolation of the mid-to-distal CS and the proximal PLSVC. CS = coronary sinus; PLSVC = persistent left superior vena cava; SVC = superior vena cava.