Feasibility and safety of left atrial access for ablation of atrial fibrillation in patients with persistent left superior vena cava.
ablation
feasibility
left atrium
persistent left superior vena cava
safety
transseptal puncture
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
revised:
02
12
2021
received:
16
06
2021
accepted:
09
01
2022
pubmed:
12
1
2022
medline:
22
4
2022
entrez:
11
1
2022
Statut:
ppublish
Résumé
In patients with persistent left superior vena cava (PLSVC) ablation procedures can be challenging. We sought to determine the feasibility and safety of left atrial ablations in patients with PLSVC, especially when PLSVC is unknown prior to the ablation procedure. In this retrospective analysis 15 adult patients (mean age 64.6 ± 14.5 years, 53.3% male) with PLSVC undergoing 27 ablation procedures for atrial fibrillation or left atrial flutter were included. In 5 (33.3%) patients PLSVC was only discovered during the procedure. Transseptal puncture (TSP) was declared "difficult" by the ablating physician in 13 of 27 (48.2%) procedures and was not successfully completed in the first attempt in two patients with known PLSVC. Once TSP was successfully completed, all relevant structures were reached both during mapping and ablation in all procedures independent of whether PLSVC was known prior to the procedure. One major complication (3.7%) occurred in 27 procedures in a patient with known PLSVC. In the patients with unknown PLSVC no complication occurred. In experienced hands, left atrial access and ablation in patients with PLSVC is feasible and safe, particularly with regard to patients in whom the PLSVC is unknown prior to the ablation procedure.
Sections du résumé
BACKGROUND
BACKGROUND
In patients with persistent left superior vena cava (PLSVC) ablation procedures can be challenging. We sought to determine the feasibility and safety of left atrial ablations in patients with PLSVC, especially when PLSVC is unknown prior to the ablation procedure.
METHODS AND RESULTS
RESULTS
In this retrospective analysis 15 adult patients (mean age 64.6 ± 14.5 years, 53.3% male) with PLSVC undergoing 27 ablation procedures for atrial fibrillation or left atrial flutter were included. In 5 (33.3%) patients PLSVC was only discovered during the procedure. Transseptal puncture (TSP) was declared "difficult" by the ablating physician in 13 of 27 (48.2%) procedures and was not successfully completed in the first attempt in two patients with known PLSVC. Once TSP was successfully completed, all relevant structures were reached both during mapping and ablation in all procedures independent of whether PLSVC was known prior to the procedure. One major complication (3.7%) occurred in 27 procedures in a patient with known PLSVC. In the patients with unknown PLSVC no complication occurred.
CONCLUSION
CONCLUSIONS
In experienced hands, left atrial access and ablation in patients with PLSVC is feasible and safe, particularly with regard to patients in whom the PLSVC is unknown prior to the ablation procedure.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
357-364Informations de copyright
© 2022 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC.
Références
Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cario-Thoracic Surgery (EACTS). Eur Heart J. 2020;42:373-498. doi:10.1093/eurheartj/ehaa612.
Arbelo E, Brugada J, Blomström-Lundqvist C, et al. Contemporary management of patients undergoing atrial fibrillation ablation: in-hospital and 1-year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry. Eur Heart J. 2017;38:1303-1316.
Hsu LF, Jais P, Keane D, et al. Atrial fibrillation originating from persistent left superior vena cava. Circulation. 2004;109:828-832.
Liu H, Lim KT, Murray C, Weerasooriya R. Electrogram-guided isolation of the left superior vena cava for treatment of atrial fibrillation. Europace. 2007;9:775-780.
Turagam M, Atoui M, Atkins D, et al. Persistent left superior vena cava as an arrhythmogenic source in atrial fibrillation: results from a multicenter experience. J Interv Card Elektrophysiol. 2019;54:93-100.
Nagasawa H, Kuwabara N, Goto H, et al. Incidence of persistent left superior vena cava in the normal population and in patients with congenital heart diseases detected using echocardiography. Pediatr Cardiol. 2018;39:484-490.
Batouty NM, Sobh DM, Gadelhak B, Sobh HM, Mahmoud W, Tawfik AM. Left superior vena cava: cross-sectional imaging overview. Radiol Med. 2020;125:237-246.
Nsah EN, Moore GW, Hutchins GM. Pathogenesis of persistent left superior vena cava with a coronary sinus connection. Pediatr Pathol. 1991;11:261-269.
Santoscoy R, Walters HL, Ross RD, Lyons JM, Hakimi M. Coronary sinus ostial atresia with persistent left superior vena cava. Ann Thorac Surg. 1996;61:879-882.
Kottmaier M, Jilek C, Berglar S, et al. Exclusion of left atrial thrombus by dual-source cardiac computed tomography prior to catheter ablation for atrial fibrillation. Clin Res Cardiol. 2019;108:150-156.
Bourier F, Reents T, Ammar-Busch S, et al. Transseptal puncture guided by CT-derived 3D-augmented fluoroscopy. J Cardiovasc Electroophysiol. 2016;27:369-372.
Ng CT, See J, Lee CW, Ching CK. Successful placement of a deflectable decapolar catheter via the right femoral vein approach in a patient with coronary sinus ostial atresia and persistent left superior vena cava. Heart Asia. 2014;6:128-129.
Luik A, Deisenhofer I, Estner H, et al. Atresia of the coronary sinus in patients with supraventricular tachycardia. PACE. 2006;29:171-174.
Gomez-Pulido F, Arana-Rueda E, Pedrote A. Atrial fibrillation ablation in a patient with absent right superior and persistent left superior vena cava. Europace. 2014;16:499.
Alkhouli M, Rihal CS, Holmes DR. Transseptal techniques for emerging structural heart interventions. JACC Cardiovasc Interv. 2016;9:2465-2480.
Erden I, Erden EC, Golcuk E, et al. Impact of transesophageal echocardiography during transseptal puncture on atrial fibrillation ablation. J Arrhythm. 2016;32:170-175.
Lakkireddy D, Rangisetty U, Prasad S, et al. Intracardiac Echo-guided radiofrequency catheter ablation of atrial fibrillation in patients with atrial septal defect or patent foramen ovale repair: a feasibility, safety, and efficacy study. J Cardiovasc Electrophysiol;19:1137-1142.
McCauley MD, Patel N, Greenberg SJ, Molina-Razavi JE, Safavi-Naeini RazaviM. Fluoroscopy-free atrial transseptal puncture. Eur J Arrhythm Electrophysiol. 2016;2:57-61.
Scaglione M, Ebrille E, Di Clemente F, Gaita F. Catheter ablation of atrial fibrillation without radiation exposure using a 3D mapping system. J Atr Fibrillation. 2015;7:1167.
Shalganov TN, Paprika D, Borbás S, Temesvári A, Szili-Török T. Preventing complicated transseptal puncture with intracardiac echocardiography: case report. Cardiovasc Ultrasound. 2005;3:5.
Elayi CS, Fahmy TS, Wazni OM, Patel D, Saliba W, Natale A. Left superior vena cava isolation in patients undergoing pulmonary vein antrum isolation: impact on atrial fibrillation recurrence. Heart Rhythm. 2006;3:1019-1023.
Chen PS, Wu TJ, Hwang C, et al. Thoracic veins and the mechanisms of non-paroxysmal atrial fibrillation. Cardiovasc Res. 2002;54:295-301.
Miyazaki S, Derval N, Shah A, Xhaet O, Haissaguere M. Mitral isthmus block in a case of persistent left superior vena cava. J Cardiovasc Electrophysiol. 2011;22:343-345.
Wissner E, Tilz R, Konstantinidou M, et al. Catheter Ablation of atrial fibrillation in patients with persistent left superior vena cava is assiciated with major intraprocedural complications. Heart Rhythm. 2010;7:1755-1760.
Deshmukh A, Patel NJ, Pant S, et al. In-hospital complications associated with catheter ablation of atria fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures. Circulation. 2013;128:2104-2112.
Steinbeck G, Sinner M, Lutz M, Müller-Nurasyid M, Kääb S, Reinecke H. Incidence of complications related to catheter ablation of atrial fibrillation and atrial flutter: a nationwide in-hospital analysis of administrative data for Germany in 2014. Eur Heart J. 2018;39:4020-4029.