Provocation and Localization of Arrhythmogenic Triggers from Persistent Left Superior Vena Cava in Patients with Atrial Fibrillation

Although pulmonary vein isolation (PVI) is an established procedure for atrial fibrillation (AF), non-PV foci play a crucial role in AF recurrence. Persistent left superior vena cava (PLSVC) has been reported as critical non-PV foci. However, the effectiveness of provocation of AF triggers from PLSV...

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Bibliographic Details
Published in:	Journal of clinical medicine Vol. 12; no. 5; p. 1783
Main Authors:	Minami, Kentaro, Nakamura, Kohki, Maeno, Eiko, Iida, Keitaro, Saito, Ikuta, Masuyama, Taiki, Kitagawa, Yoshiyuki, Nakajima, Toshiaki, Nakatani, Yosuke, Naito, Shigeto, Toyoda, Shigeru, Chovanec, Milan, Petrů, Jan, Škoda, Jan, Kumagai, Koji, Neužil, Petr
Format:	Journal Article
Language:	English
Published:	Switzerland MDPI AG 23-02-2023 MDPI
Subjects:	Ablation Atrial fibrillation Blood vessels Cardiac arrhythmia Cardiovascular disease Care and treatment Catheters Complications and side effects Drug dosages Ejection fraction Electrocardiography Health aspects Localization Medical imaging Patients Surgery Veins & arteries Vena cava Japan United States > US persistent left superior vena cava atrial fibrillation catheter ablation
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Summary:	Although pulmonary vein isolation (PVI) is an established procedure for atrial fibrillation (AF), non-PV foci play a crucial role in AF recurrence. Persistent left superior vena cava (PLSVC) has been reported as critical non-PV foci. However, the effectiveness of provocation of AF triggers from PLSVC remains unclear. This study was designed to validate the usefulness of provoking AF triggers from PLSVC. This multicenter retrospective study included 37 patients with AF and PLSVC. To provoke triggers, AF was cardioverted, and re-initiation of AF was monitored under high-dose isoproterenol infusion. The patients were divided into two groups: those whose PLSVC had arrhythmogenic triggers initiating AF (Group A) and those whose PLSVC did not have triggers (Group B). Group A underwent isolation of PLSVC after PVI. Group B received PVI only. Group A had 14 patients, whereas Group B had 23 patients. After a 3-year follow-up, no difference in the success rate for maintaining sinus rhythm was observed between the two groups. Group A was significantly younger and had lower CHADS2-VASc scores than Group B. The provocation of arrhythmogenic triggers from PLSVC was effective for the ablation strategy. PLSVC electrical isolation would not be necessary if arrhythmogenic triggers are not provoked.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2077-0383 2077-0383
DOI:	10.3390/jcm12051783