Objectives To analyse the characteristics of electrocardiogram (ECG) and electrophysiologic and radiofrequency catheter ablation (RFCA), to investigate the diagnosis and strategy of ablation of Atrial Arrhythmia originating from Superior Vena Cava.
Methods Choose 14 patients from 2002–2013, all patients acknowledged atrial arrhythmia (atrial fibrillation (AF), atrial tachycardia (AT)) originating from superior vena cava by electrophysiologic examination. 6 of them were male, and the mean age of the 14 patients was 56 ± 7 years, mean case history was 8 ± 7 years. Analyse the ECG P’ waves of atrial premature or atrial tachycardia and electrophysiologic characteristics. When atrial fibrillation, atrial tachycardia happens, identify the origin location and the earliest activation, under the guidance of traditional mapping or three-dimensional (3D) mapping system, combined SVC angiography, if certify SVC is the origin of triggering arrhythmia, ablate the SVC focally, segmentally or circularly.
Results Though the 14 cases of atrial arrhythmia originated from SVC, We found that the ECG P’ waves characteristics: 13 patients the P’ waves in lead I were positive, 1 was isoeleetric; 14 patients the P’ waves in lead II were positive, and the amplitude was higher than sinusus P wave; 12 patients the waves in lead III were positive, 2 were positive negative; 13 patients the P’ waves in lead AVF were positive, 1 was isoeleetric; 14 patients the P waves in lead AVR were all negative; the patients of P’ waves in lead V1 positive, negative, positive negative, isoeleetric was 5, 3, 4, 2 respectively. Compared with the sinusus P wave, the P’ waves was significantly higher in lead II, III, AVF. The electrophysiologic characteristics: In SVC and right superior pulmonary veins (RSPV), could record SVC potential, which ahead of coronary sinus ostium (CSO) 50 ± 11 ms sinus rhythm, 93 ± 20 ms atrial premature, p < 0.01; SVC electric activity may trigger atrial fibrillation, atrial tachycardia, compared with the any other positions of atrium, SVC electric activity has the feature of earlier excitation and faster frequency; pacing SVC may trigger atrial fibrillation, atrial tachycardia; during the ablation of SVC, SVC remain the quick and confused electric activity when AF transferred sinus rhythm, however the atrium was stable electric activity, during continuing ablation, the SVC potential disappears, sometimes SVC automatic happens. 5 patients of AT ablated successly instantly, 9 patients of AF and atrial premature, mapping and ablation under the 3D mapping system, 1 patient happened sinus arrest, 1 happened cardiac tamponade. No surgery relevant complication and recurrence during follow up.
Conclusions Atrial arrhythmia originating from superior vena cava has typical ECG characteristics: P’ waves in lead II, III, AVF was significantly higher than sinusus P wave. The time limit of SVC potential ahead of CSO both sinus rhythm and atrial premature has direction meaning to some extent, which could improve the success rate and decrease recurrence rate. The focal ablation and segmental ablation of SVC could achieve SVC-RA completely electrical isolation. SVC is adjacent to atrionector and right nervus phrenicus anatomically, 3D mapping system is helpful to identify anatomy and target location.
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