Electroanatomic mapping and catheter ablation of breakthroughs from the right atrium to the superior vena cava in patients with atrial fibrillation.
BACKGROUND
The superior vena cava (SVC) is one of the sources of ectopies that can initiate atrial fibrillation (AF). We investigated by radiofrequency ablation the electrophysiological characteristics of the junction of the right atrium (RA) and the SVC and the feasibility of electrical disconnection of the SVC from the RA.


RESULTS
Sixteen patients with paroxysmal AF after pulmonary vein isolation underwent electroanatomic mapping at the RA-SVC junction during sinus rhythm. Mapping showed sharp potentials (SVC potentials) inside the SVC. Activation spread from the earliest SVC potential (breakthrough) to the rest of the SVC. SVC potentials were found over a large amount of the circumference, suggesting widespread muscle coverage of the SVC. Breakthroughs from the RA to SVC were located anteriorly, laterally, posteriorly, and septally in 3, 4, 10, and 6 patients, respectively. The number of breakthroughs was 1.4+/-0.5 per patient. Radiofrequency energy was applied with the end point of electrical disconnection. All breakthroughs were eliminated with 3.1+/-1.7 applications per breakthrough without complications.


CONCLUSIONS
SVC potentials can be recorded inside the SVC. There are specific breakthroughs from the RA to the SVC that can be identified by electroanatomic mapping. The electrical disconnection of the SVC from the RA is feasible.
Goya
Masahiko
M
llgemeines Krankenhaus St Georg, 2. Med. Abteilung, Kardiologie, Hamburg, Germany.
Ouyang
Feifan
F
Ernst
Sabine
S
Volkmer
Marius
M
Antz
Matthias
M
Kuck
Karl-Heinz
KH
D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery; D014683:Vena Cava, Superior / Q000503:physiopathology / Q000601:surgery*