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Gao M, Bian Y, Huang L, Zhang J, Li C, Liu N, Liu X, Zuo S, Guo X, Wang W, Zhao X, Long D, Sang C, Tang R, Li S, Dong J, Ma C. Catheter ablation for atrial fibrillation in patients with persistent left superior vena cava: Case series and systematic review. Front Cardiovasc Med 2022; 9:1015540. [PMID: 36337869 PMCID: PMC9632661 DOI: 10.3389/fcvm.2022.1015540] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/30/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Persistent left superior vena cava (PLSVC) is the most common form of thoracic venous abnormality. Catheter ablation (CA) for atrial fibrillation (AF) can be complicated by the existence of PLSVC, which could act as an important arrhythmogenic mechanism in AF. Methods and results We reported a case series of patients with PLSVC who underwent CA for AF at our center between 2018 and 2021. A systematic search was also performed on PubMed, EMBASE, and Web of Science for research reporting CA for AF in patients with PLSVC. Sixteen patients with PLSVC were identified at our center. Ablation targeting PLSVC was performed in 5 patients in the index procedures and in four patients receiving redo procedures. One patient experienced acute procedure failure. After a median follow-up period of 15 months, only 6 (37.5%) patients remained free from AF/atrial tachycardia (AT) after a single procedure. In the systematic review, 11 studies with 167 patients were identified. Based on the included studies, the estimated prevalence of PLSVC in patients undergoing CA for AF was 0.7%. Ablation targeting PLSVC was performed in 121 (74.7%) patients. Major complications in patients with PLSVC receiving AF ablation procedure included four cases of cardiac tamponades (2%), three cases of cardiac effusion (1.5%), one case of ischemic stroke, and three cases of phrenic nerve injury (1.5%) (one left phrenic nerve and two right phrenic nerve). Pooled analysis revealed that after a median follow-up period of 15.6 months (IQR 12.0–74.0 months), the long-term AF/AT-free rate was 70.6% (95% CI 62.8–78.4%, I2 = 0.0%) (Central illustration). Different ablation strategies for PLSVC were summarized and discussed in the systematic review. Conclusion In patients with PLSVC, recurrence of atrial arrhythmia after CA for AF is relatively common. Ablation aiming for PLSVC isolation is necessitated in most patients. The overall risk of procedural complications was within an acceptable range.
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Affiliation(s)
- Mingyang Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Bian
- Department of Cardiology, Baoji Hospital Affiliated to Xi’an Medical University, Baoji, Shaanxi, China
| | - Lihong Huang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jingrui Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changyi Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoxia Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Song Zuo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xueyuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- *Correspondence: Songnan Li,
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Miyazaki S, Hasegawa K, Yamao K, Mukai M, Aoyama D, Sekihara T, Nodera M, Eguchi T, Iesaka Y, Tada H. High-Resolution Mapping and Ablation of Atrial Tachycardias Involving the Lateral Left Atrium. J Am Heart Assoc 2021; 10:e022384. [PMID: 34581187 PMCID: PMC8751894 DOI: 10.1161/jaha.121.022384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The lateral left atrium (LA) is often associated with atrial tachycardia (AT) because of its complex anatomy. We sought to characterize ATs associated with the lateral LA, including the posterolateral mitral isthmus (MI) and left atrial ridge. Methods and Results Twenty‐eight lateral LA‐associated ATs were mapped with high‐resolution mapping systems and entrainment pacing. The vein of Marshall was mapped with a 1.8‐Fr mapping catheter when possible. ATs were associated with the posterolateral MI in 18 ATs (14 perimitral, 3 small reentry, and 1 focal AT). All patients had undergone MI area ablation, and all ATs were successfully eliminated. During 27.0 (interquartile range, 10.5–40.0) months of follow‐up, all were free from any atrial tachyarrhythmias, with 3 patients on antiarrhythmics. Of 10 ATs involving the ridge or Marshall bundle, 3 were ridge related, 3 were Marshall bundle related based on vein of Marshall mapping, and 1 was a persistent left superior vena cava related AT. All 7 patients had undergone MI linear ablation. The critical isthmus was in the LA‐ridge junction or the LA‐Marshall bundle junction. Bidirectional conduction block between the LA and ridge or Marshall bundle was created. Two patients had the critical isthmus in the other area. The remaining patient had micro‐reentry in the ridge. All 10 ATs were terminated during ablation at the critical isthmus. During 12.0 (5.2–31.7) months of follow‐up, all were free from any atrial tachyarrhythmias, with 7 patients on antiarrhythmics. Conclusions Most ATs occurred after MI area ablation. An high resolution mapping‐guided approach is highly effective for identifying the mechanism.
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Affiliation(s)
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine University of Fukui Japan
| | - Kazuya Yamao
- Cardiovascular Center Tsuchiura Kyodo Hospital Tsuchiura Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine University of Fukui Japan
| | - Daisetsu Aoyama
- Department of Cardiovascular Medicine University of Fukui Japan
| | | | - Minoru Nodera
- Department of Cardiovascular Medicine University of Fukui Japan
| | - Tomoya Eguchi
- Department of Cardiovascular Medicine University of Fukui Japan
| | - Yoshito Iesaka
- Cardiovascular Center Tsuchiura Kyodo Hospital Tsuchiura Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine University of Fukui Japan
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Suzuki K, Yamagata K, Noda T, Nagase S, Yambe T, Kusano K. A case of macroreentrant atrial tachycardia between a persistent left superior vena cava and the left atrium with a decremental property. HeartRhythm Case Rep 2020; 6:836-840. [PMID: 33204617 PMCID: PMC7653479 DOI: 10.1016/j.hrcr.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Keisuke Suzuki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
- Institute of Development Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichiro Yamagata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
- Address reprint requests and correspondence: Dr Kenichiro Yamagata, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe Shin-Machi, Suita, Osaka 564-8565, Japan.
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomoyuki Yambe
- Institute of Development Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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