doi: 10.2169/internalmedicine.8588-16 Intern Med 56: 2239-2240, 2017 http://internmed.jp

【 PICTURES IN CLINICAL MEDICINE 】

AF Sustained in Only a Small Area of SVC Takahiko Nagase, Ritsushi Kato, So Asano and Kazuo Matsumoto Key words: atrial fibrillation, superior vena cava, catheter ablation

(Intern Med 56: 2239-2240, 2017) (DOI: 10.2169/internalmedicine.8588-16)

Picture 2.  Picture 1. 

Picture 3. 

Picture 4. 

A 66-year-old female was admitted to our hospital to undergo catheter ablation for symptomatic paroxysmal atrial fibrillation (AF). After pulmonary vein isolation was achieved by cryoballoon and adenosine triphosphate was injected to confirm the dormant conduction of the pulmonary

veins, AF was induced. Sinus rhythm was restored by cardioversion, whereas AF was sustained only in the superior vena cava (SVC) (Picture 1 and 2). Mapping under a 3D mapping system revealed that AF was sustained in only a very small area of SVC (13.6 cm2) (Picture 3 and 4). All ar-

Department of Cardiology, Saitama Medical University, International Medical Center, Japan Received: November 20, 2016; Accepted: December 27, 2016; Advance Publication by J-STAGE: August 1, 2017 Correspondence to Dr. Ritsushi Kato, [email protected]

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Intern Med 56: 2239-2240, 2017

DOI: 10.2169/internalmedicine.8588-16

eas in SVC returned to sinus rhythm during the isolation of SVC. SVC is important for non-pulmonary vein focus and the maintenance of AF. Conduction blocks and the heterogenicity of the histological structure in SVC has also been reported (1, 2). This case was rare in the respect that we could detect a very small area of sustained AF in SVC using the 3D mapping system.

References

The authors state that they have no Conflict of Interest (COI).

1. Tsai CF, Tai CT, Hsieh MH, et al. Initiation of atrial fibrillation by ectopic beats originating from the superior vena cava. Electrophysiological characteristics and results of radiofrequency ablation. Circulation 102: 67-74, 2000. 2. Yeh HI, Lai YJ, Lee SH, et al. Heterogeneity of myocardial sleeve morphology and gap junction in canine superior vena cava. Circulation 104: 3152-3157, 2001. The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/ by-nc-nd/4.0/).

Ⓒ 2017 The Japanese Society of Internal Medicine Intern Med 56: 2239-2240, 2017

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