title: Atrial fibrillation originating from persistent left superior vena cava.
abstract: BACKGROUND
  The left superior vena cava (LSVC) is the embryological precursor of the ligament of Marshall, which has been implicated in the initiation and maintenance of atrial fibrillation (AF). Rarely, the LSVC may persist and has been associated with some organized arrhythmias, though not with AF. We report 5 patients in whom the LSVC was a source of ectopy, initiating AF.
  
  
  RESULTS
  In 5 patients (4 men; age, 46+/-11 years) with symptomatic drug-refractory AF, ectopy from the LSVC resulting in AF was observed after pulmonary vein isolation. The ectopics were spontaneous in 2 and induced by isoproterenol in the others and preceded P-wave onset by 67+/-13 ms. During multielectrode or electroanatomic mapping, venous potentials were recorded circumferentially at the proximal LSVC near its junction with the coronary sinus (CS), but at the mid-LSVC level, they were recorded only on part of the circumference. The LSVC was electrically connected to the lateral left atrium (LA) and through the CS to the right atrium, with 4.1+/-2.3 CS-LSVC and 1.6+/-0.5 LA-LSVC connections per patient. Catheter ablation in the LSVC targeting these connections resulted in electrical isolation in 4 of the 5 patients without complications. After 15+/-10 months, the 4 patients with successful isolation, including 1 who had successful reablation for LA flutter, remained in sinus rhythm without drugs.
  
  
  CONCLUSIONS
  The LSVC can be the arrhythmogenic source of AF with connections to the CS and LA. Ablation of these connections resulted in electrical isolation.
authors.affiliation: Hôpital Cardiologique du Haut-Lévèque, Bordeaux-Pessac, France. hsulifern@yahoo.com.sg
authors.forename: Li-Fern
authors.initials: LF
authors.lastname: Hsu
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.forename: David
authors.initials: D
authors.lastname: Keane
authors.forename: J Marcus
authors.initials: JM
authors.lastname: Wharton
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Dipen C
authors.initials: DC
authors.lastname: Shah
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.forename: Christophe
authors.initials: C
authors.lastname: Scavée
authors.forename: Rukshen
authors.initials: R
authors.lastname: Weerasooriya
authors.forename: Jacques
authors.initials: J
authors.lastname: Clémenty
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D000318:Adrenergic beta-Agonists; D000328:Adult; D001281:Atrial Fibrillation / Q000209:etiology* / Q000628:therapy; D018880:Atrial Premature Complexes / Q000209:etiology*; D006328:Cardiac Catheterization; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007545:Isoproterenol; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000002:abnormalities* / Q000196:embryology / Q000601:surgery
chemical_list: D000318:Adrenergic beta-Agonists; D007545:Isoproterenol