Atrial Fibrillation Originating from Persistent Left Superior Vena Cava

Li Fern Hsu, Pierre Jaïs, David Keane, J. Marcus Wharton, Isabel Deisenhofer, Mélèze Hocini, Dipen C. Shah, Prashanthan Sanders, Christophe Scavée, Rukshen Weerasooriya, Jacques Clémenty, Michel Haïssaguerre

Research output: Contribution to journalArticle

135 Citations (Scopus)

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. Methods and 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.

LanguageEnglish
Pages828-832
Number of pages5
JournalCirculation
Volume109
Issue number7
DOIs
Publication statusPublished - 24 Feb 2004

Keywords

  • Catheter ablation
  • Fibrillation
  • Mapping

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Hsu, L. F., Jaïs, P., Keane, D., Wharton, J. M., Deisenhofer, I., Hocini, M., ... Haïssaguerre, M. (2004). Atrial Fibrillation Originating from Persistent Left Superior Vena Cava. Circulation, 109(7), 828-832. https://doi.org/10.1161/01.CIR.0000116753.56467.BC
Hsu, Li Fern ; Jaïs, Pierre ; Keane, David ; Wharton, J. Marcus ; Deisenhofer, Isabel ; Hocini, Mélèze ; Shah, Dipen C. ; Sanders, Prashanthan ; Scavée, Christophe ; Weerasooriya, Rukshen ; Clémenty, Jacques ; Haïssaguerre, Michel. / Atrial Fibrillation Originating from Persistent Left Superior Vena Cava. In: Circulation. 2004 ; Vol. 109, No. 7. pp. 828-832.
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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. Methods and 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.",
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Hsu, LF, Jaïs, P, Keane, D, Wharton, JM, Deisenhofer, I, Hocini, M, Shah, DC, Sanders, P, Scavée, C, Weerasooriya, R, Clémenty, J & Haïssaguerre, M 2004, 'Atrial Fibrillation Originating from Persistent Left Superior Vena Cava', Circulation, vol. 109, no. 7, pp. 828-832. https://doi.org/10.1161/01.CIR.0000116753.56467.BC

Atrial Fibrillation Originating from Persistent Left Superior Vena Cava. / Hsu, Li Fern; Jaïs, Pierre; Keane, David; Wharton, J. Marcus; Deisenhofer, Isabel; Hocini, Mélèze; Shah, Dipen C.; Sanders, Prashanthan; Scavée, Christophe; Weerasooriya, Rukshen; Clémenty, Jacques; Haïssaguerre, Michel.

In: Circulation, Vol. 109, No. 7, 24.02.2004, p. 828-832.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Atrial Fibrillation Originating from Persistent Left Superior Vena Cava

AU - Hsu, Li Fern

AU - Jaïs, Pierre

AU - Keane, David

AU - Wharton, J. Marcus

AU - Deisenhofer, Isabel

AU - Hocini, Mélèze

AU - Shah, Dipen C.

AU - Sanders, Prashanthan

AU - Scavée, Christophe

AU - Weerasooriya, Rukshen

AU - Clémenty, Jacques

AU - Haïssaguerre, Michel

PY - 2004/2/24

Y1 - 2004/2/24

N2 - 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. Methods and 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.

AB - 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. Methods and 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.

KW - Catheter ablation

KW - Fibrillation

KW - Mapping

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Hsu LF, Jaïs P, Keane D, Wharton JM, Deisenhofer I, Hocini M et al. Atrial Fibrillation Originating from Persistent Left Superior Vena Cava. Circulation. 2004 Feb 24;109(7):828-832. https://doi.org/10.1161/01.CIR.0000116753.56467.BC