Yun Gi Kim1, Seongwook Han2, Jong-Il Choi1, Kwang-No Lee1, Yong-Soo Baek1, Jae-Sun Uhm3, Jaemin Shim1, Jin Seok Kim1, Sang Weon Park1, Chun Hwang4, Young-Hoon Kim1. 1. Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea. 2. Division of Cardiology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea. 3. Yonsei Cardiovascular Hospital, Yonsei Health System, Seoul, Republic of Korea. 4. Central Utah Medical Clinic Cardiology, Utah Valley Regional Medical Center, 1055 North 500 West, Provo, UT 84006, USA.
Abstract
AIMS: The impact of persistent left superior vena cava (PLSVC) in atrial fibrillation (AF) patients undergoing radiofrequency catheter ablation (RFCA) is not well known. We performed this analysis to evaluate the electrophysiological characteristics of PLSVC and its role in triggering and maintaining AF. METHODS AND RESULTS: Patients with AF referred to two tertiary hospitals were screened and patients with PLSVC in pre-RFCA imaging studies were enrolled. Among 3967 patients, PLSVC was present in 36 patients (0.9%). There were four morphological types of PLSVC: type 1, atresia of the right superior vena cava (SVC) (n = 2); type 2A, dual SVCs with an anastomosis between right and left SVCs (n = 15); type 2B, dual SVCs without an anastomosis (n = 16); type 3, PLSVC draining into the left atrium (LA; n = 2); and unclassified in one patient. Thirty-two patients underwent RFCA and electrophysiology study focusing on PLSVC: PLSVC was the trigger of AF in 48.4% of patients and the driver of AF in 46.9% of patients. Cumulatively, PLSVC was a trigger or driver of AF in 22 patients (68.8%). Whether to ablate PLSVC was determined by the results of electrophysiology study, and no significant difference in the late recurrence rate was observed between patients who did and did not have either trigger or driver from PLSVC. CONCLUSION: Pre-RFCA cardiac imaging revealed PLSVC in 0.9% of AF patients. This study demonstrated that PLSVC has an important role in initiating and maintaining AF in substantial proportion of patients. Electrophysiology study focusing on PLSVC can help to decide whether to ablate PLSVC. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The impact of persistent left superior vena cava (PLSVC) in atrial fibrillation (AF) patients undergoing radiofrequency catheter ablation (RFCA) is not well known. We performed this analysis to evaluate the electrophysiological characteristics of PLSVC and its role in triggering and maintaining AF. METHODS AND RESULTS:Patients with AF referred to two tertiary hospitals were screened and patients with PLSVC in pre-RFCA imaging studies were enrolled. Among 3967 patients, PLSVC was present in 36 patients (0.9%). There were four morphological types of PLSVC: type 1, atresia of the right superior vena cava (SVC) (n = 2); type 2A, dual SVCs with an anastomosis between right and left SVCs (n = 15); type 2B, dual SVCs without an anastomosis (n = 16); type 3, PLSVC draining into the left atrium (LA; n = 2); and unclassified in one patient. Thirty-two patients underwent RFCA and electrophysiology study focusing on PLSVC: PLSVC was the trigger of AF in 48.4% of patients and the driver of AF in 46.9% of patients. Cumulatively, PLSVC was a trigger or driver of AF in 22 patients (68.8%). Whether to ablate PLSVC was determined by the results of electrophysiology study, and no significant difference in the late recurrence rate was observed between patients who did and did not have either trigger or driver from PLSVC. CONCLUSION: Pre-RFCA cardiac imaging revealed PLSVC in 0.9% of AFpatients. This study demonstrated that PLSVC has an important role in initiating and maintaining AF in substantial proportion of patients. Electrophysiology study focusing on PLSVC can help to decide whether to ablate PLSVC. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Yun Gi Kim; Kwang-No Lee; Kyung-Do Han; Kyu-Man Han; Kyongjin Min; Ha Young Choi; Yun Young Choi; Jaemin Shim; Jong-Il Choi; Young-Hoon Kim Journal: JAMA Netw Open Date: 2022-01-04
Authors: Shota Tohoku; Boris Schmidt; Stefano Bordignon; Shaojie Chen; Fabrizio Bologna; Lukas Urbanek; Francesco Pansera; K R Julian Chun Journal: JACC Case Rep Date: 2022-03-02
Authors: Yun Gi Kim; Ha Young Choi; Jaemin Shim; Kyongjin Min; Yun Young Choi; Jong-Il Choi; Young-Hoon Kim Journal: Korean Circ J Date: 2021-12-21 Impact factor: 3.243