Key result
SVC ostial ablation restores immediate sinus rhythm in refractory paroxysmal AF.
Why the study?
The superior vena cava can be a source of non-pulmonary vein triggers in atrial fibrillation patients, but its role and ablation outcomes require clarification.
Case Report (n=1)
No
May warrant SVC mapping in select refractory AF cases; leaves open whether isolation improves outcomes in prospective trials.
We report the case of a 66 year-old male who underwent catheter ablation for drug-refractory paroxysmal atrial fibrillation (AF) at our institution. Radiofrequency catheter ablation was performed using a three-dimensional electroanatomical mapping system. During ablation of the pulmonary veins (PV), right atrial ectopics were noted to repeatedly trigger AF and atrial tachycardia (AT). After PV isolation, mapping of the right atrium revealed that the superior vena cava (SVC) was in AF, while both atria were in an organized AT. Segmental ablation was performed around the SVC ostium, resulting in vein isolation and immediate restoration of sinus rhythm, while the SVC remained in AF. This case highlights the importance of the SVC in some AF patients as a potential source for non-PV triggers. SVC isolation can be safely achieved in most cases to improve outcomes.
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Enriquez et al. (2017) conducted a case report in Drug-refractory paroxysmal atrial fibrillation (n=1). Segmental ablation around the superior vena cava (SVC) ostium was evaluated on Restoration of sinus rhythm. Segmental ablation around the superior vena cava ostium resulted in immediate restoration of sinus rhythm in a patient with drug-refractory paroxysmal atrial fibrillation.
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