Document Detail

Superior vena cava as initiator of atrial fibrillation: factors related to its arrhythmogenicity.
MedLine Citation:
PMID:  20470902     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The superior vena cava (SVC) is an important focus of atrial fibrillation (AF) for which SVC isolation is effective. However, SVC isolation may cause serious complications, and indications for SVC isolation combined with pulmonary vein (PV) isolation are unclear.
OBJECTIVE: The purpose of this study was to identify structural and electrophysiologic differences that might exist between the SVC of patients with and those without SVC triggering of AF.
METHODS: This study included paroxysmal (n = 46) and persistent (n = 14) AF patients without structural heart disease who underwent circumferential antral PV isolation. Patients with AF of SVC origin were assigned to the SVC group (n = 12); the remaining patients were assigned to the control group (n = 48). The area where SVC potentials were recorded was defined as the SVC sleeve. The length of the SVC sleeve and the maximum amplitude of the SVC potential were measured.
RESULTS: SVC group patients had a longer SVC sleeve (34.7 +/- 4.4 mm vs 16.5 +/- 11.4 mm, P <.0001) than did control group patients. Maximum amplitude of the SVC potential was greater in SVC group patients than in control group patients (1.50 +/- 0.43 mV vs 0.98 +/- 0.60 mV, P = .03). SVC sleeve length >30 mm and maximum amplitude of SVC potential >1.0 mV strongly predicted an SVC focus of AF (100% sensitivity, 94% specificity). Fifty of 60 patients became AF-free without antiarrhythmic drugs after undergoing circumferential antral PV isolation and/or SVC isolation.
CONCLUSION: The results of this study suggest that in patients with long SVC sleeve (>30 mm) and large SVC potential (>1.0 mV), arrhythmogenic triggers of AF reside in the SVC.
Koji Higuchi; Yasuteru Yamauchi; Kenzo Hirao; Takeshi Sasaki; Hitoshi Hachiya; Yukio Sekiguchi; Junichi Nitta; Mitsuaki Isobe
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-05-12
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  7     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-31     Completed Date:  2011-01-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1186-91     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
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MeSH Terms
Atrial Fibrillation / etiology*,  physiopathology,  surgery
Body Surface Potential Mapping / methods
Catheter Ablation / methods*
Follow-Up Studies
Heart Conduction System / physiopathology*,  surgery
Middle Aged
Retrospective Studies
Treatment Outcome
Vena Cava, Superior / physiopathology*,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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