Isolation of Superior Vena Cava

Abstract

Superior vena cava (SVC) is one of the most important non-pulmonary vein (PV) origins of paroxysmal atrial fibrillation (AF), and electrical SVC isolation (SVCI) from right atrium (RA) is effective to treat SVC-related paroxysmal AF. The isolation line for SVCI is about 5 mm above the “electrical” SVC-RA junction. SVCI should be carefully performed because of potential complications such as phrenic nerve paralysis, sinus node injury, and SVC stenosis. There are two different indication of SVCI to treat SVC-related AF. The conventional indication is that performing SVCI only for SVC with confirmed AF triggers. Another approach is the empiric SVCI in addition to PV isolation (PVI) for all paroxysmal AF patients. Both approaches are effective, however, empiric SVCI should be limited for SVC with arrhythmogenic property, which is SVC with long myocardial extension.