Left Persistent Superior Vena Cava As An Arrhythmogenic Source In Atrial Fibrillation, A Large Multicenter Observational Study

Introduction: the left persistent superior vena cava (LPSVC) is one of the most frequent congenital anomalies. It has been described in few reported cases to be implicated in the initiation and maintenance of atrial fibrillation (AF). We are presenting the largest multicenter observational report in patients who underwent LPSVC ablation during their AF ablation procedure. Methods: From multiple US centers, we reviewed all patients who underwent ablation of the LPSVC during AF ablation procedure. Available demographics, electronic medical records, procedural details and outcomes were reviewed. Results: A total of 25 patients with symptomatic drug refractory AF were included. All patients underwent a radiofrequency ablation of the LPSVC as part of their procedure. Mean age was 57 years. 14 (56%) patients did have paroxysmal AF at the time of the procedure. Only 5 (20%) paroxysmal AF patients had their LPSVC ablation performed at the initial procedure. In the remaining 20 (80%) patients, they underwent at least one failed previous ablation but none with an ablation to the LPSVC. There was no recurrence or redo procedures noted in the followed patients. One complication of mild asymptomatic LPSVC stenosis was noted and followed conservatively. Conclusion: In this largest observational report, LPSVC was involved in the arrhythmogenesis of paroxysmal and persistent AF. Ablation of the LPSVC ablation was safely performed with electrical isolation and no further recurrence.