Pulsed field ablation of a persistent left superior vena cava in recurrent paroxysmal atrial fibrillation and its effect on the mitral isthmus: A case report
Roberto Menè, Vasileios Sousonis, Stéphane Combes, Alice Maltret, Jean‐Paul Albenque, Nicolas Combes
Abstract
Key Teaching Points•Persistent left superior vena cava (LSVC) is a common anatomic variant that is associated to an increased risk of atrial fibrillation and poses significant challenges during ablation with traditional thermal energy sources.•Pulsed field ablation may be a safe, fast, and effective strategy to ablate a persistent LSVC that overcomes the limitations of the currently available thermal energy sources.•Ablation of an LSVC may have transmural effect and therefore result in the formation of a potentially arrhythmogenic incomplete line of block at the level of the mitral isthmus. Therefore, endocardial mapping of the mitral isthmus should always be taken into consideration following this procedure and, when appropriate, additional endocardial applications may be performed to achieve a complete line of block. •Persistent left superior vena cava (LSVC) is a common anatomic variant that is associated to an increased risk of atrial fibrillation and poses significant challenges during ablation with traditional thermal energy sources.•Pulsed field ablation may be a safe, fast, and effective strategy to ablate a persistent LSVC that overcomes the limitations of the currently available thermal energy sources.•Ablation of an LSVC may have transmural effect and therefore result in the formation of a potentially arrhythmogenic incomplete line of block at the level of the mitral isthmus. Therefore, endocardial mapping of the mitral isthmus should always be taken into consideration following this procedure and, when appropriate, additional endocardial applications may be performed to achieve a complete line of block.