High-density Mapping Of The Electrical Anatomical Structure Of The Superior Vena Cava And The Electrophysiological Characteristics Of Atrial Fibrillation Originating From The Superior Vena Cava

Part ?:Electrical Anatomic Structure of Super Vena Cava under High-resolution MappingBackground and Objective:Circumferential pulmonary vein isolation(CPVI)is the most effective treatment for paroxysmal atrial fibrillation(PAF).Recently,studies revealed that part of atrial fibrillation are not pulmonary venin triggered.CPVI is not suitable for these patients.Super vena cava(SVC)is most conmon trigger place for non-pulraonary trigger AF,and its incidence,according to reports,is around 5.3-12.8Y.The most common complications for SVC isolation is phrenic nerve injure(2%),sinus nodes injure(2-4.5%)due to the vicinity of right phrenic nerve and sinus node.So we decide to perform high-resolution mapping for superior vena cava in sinus rhythm to reduce related complications due to ablation.Method Twenty four atrial fibrillation patients who have received circumferential pulmonary vein isolation(CPVI)underwent high-resolution mapping in sinus rhythm,the location of sinus node(SN)and phrenic nerve(PN)and electric breakthrough points were noted.Then the connection between right atrial to SVC were ablated under the guide of circular catheter.Result SN varies in location(lateral;75%,anterior:12.5%,posterior:12.50%),while PN predominantly located in lateral wall(87.5%)with few in the posterior wall(12.5%).The successful ablation points are mainly in anterior wall and posterior septal wall.After ablation,the heart rate increased from 74.5± 14.6bpm to 81.0± 13.0 bpm,P=0.007,23(95.8%)patients received super vena cava isolation(SVCI),only one case failed to perform ablation due to the location of PN and breakthrough site were at the same spot.Patients who received SVCI don't have any complications like SN injure,PN injure and SVC stenosis,and so on.Conclusion The SN location varied from individuals,however,the successful SVC isolation site are located in anterior wall and posterior septal wall.SVC isolation under the guidance of high-resolution is safe and effective.Part ?:The Clinical Feature of Atrial Fibrillation Triggered from Super Vena CaveBackground and Objective:Atrial fibrillation(AF)triggered by super vena cave(SVC)is not rare in clinical field,its incidence is around 5.3-12.8%.Empiric and conventional isolation of SVC might improve the outcome after catheter ablation of atrial fibrillation theoretically.However,accounting of its time cost and complication related,early identification whether its triggered from svc is beneficial.This study is try to find out some predictors for SVC trigger atrial fibrillation before catheter ablation.Methods:Retrospective analysis of 726 paroxysmal atrial fibrillation patients in fuwai hospital from January 2013 to April 2019.And 10 cases were confirmed to be triggered from SVC.And their clinical data and electrophysiological data were collected and analysis.outcome:By comparing the SVC triggered atrial fibrillation and non-SVC triggered atrial fibrillation patients,we found out that SVC triggered atrial fibrillation patients has much smaller left atrial diameter(LAD)and history of prior catheter ablation.The preferential conduction bundle from SVC-RA is about 2.7±0.6 per patients,and predominately located in the posterior lateral wall.After follow-up,there is not any complications like SVC stenosis,sinus nodes injure,phrenic nerve injure,and so on.Conclusion:Paroxysmal atrial patients which had prior ablation procedures,small LAD,are more likely to present with SVC firing.Electrocardiogram is also useful tool to diagnose whether it's SVC triggered.SVC isolation under three dimension mapping is effective and safety.