title: Left superior vena cava isolation in patients undergoing pulmonary vein antrum isolation: impact on atrial fibrillation recurrence.
abstract: BACKGROUND
  A persistent left superior vena cava (SVC) can be an arrhythmogenic source in patients with atrial fibrillation (AF) through connections from the coronary sinus (CS) and the left atrium (LA). The left SVC can be electrically isolated. However, little clinical data about the impact of left SVC disconnection on AF outcome are available. We report on six patients with left SVC and recurrent AF.
  
  
  OBJECTIVE
  The purpose of this study was to assess the impact of left SVC isolation on AF recurrence.
  
  
  METHODS
  Six patients (4 men and 2 women; age 50 +/- 6.4 years) with symptomatic drug-refractory AF and persistent left SVC presented to our laboratory for treatment. Four of the patients had left SVC isolation only because there was no conduction recovery in the pulmonary veins (PVs) after several previous procedures.
  
  
  RESULTS
  Conduction between the left SVC and the CS and LA was documented, as was spontaneous ectopies in three patients that degenerated into AF in one patient. Isolation of the left SVC was successful in all patients. Isolation was relatively easy to perform (10.25 +/- 1.6 minutes), with no complications. After follow-up of 13 +/- 7.4 months, all patients were in sinus rhythm and free from AF without antiarrhythmic drugs.
  
  
  CONCLUSIONS
  This study stresses the importance of looking for unusual sources of AF in patients presenting for repeat procedures or in those in whom the PVs have been ruled out as a source triggering AF. We present clinical evidence that in patients with AF and left SVC, isolation of the PVs only may not be sufficient to suppress AF. Thus, diagnosis and isolation of the left SVC appears critical to preventing AF recurrence in patients with AF when ablation is considered.
authors.affiliation: Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: Claude S
authors.initials: CS
authors.lastname: Elayi
authors.forename: Tamer S
authors.initials: TS
authors.lastname: Fahmy
authors.forename: Oussama M
authors.initials: OM
authors.lastname: Wazni
authors.forename: Dimpi
authors.initials: D
authors.lastname: Patel
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology*