Turagam Mohit K, Atoui Moustapha, Atkins Donita, Di Biase Luigi, Shivkumar Kalyanam, Jared Bunch T, Mohanty Sanghamitra, Gianni Carola, Natale Andrea, Lakkireddy Dhanunjaya
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
St. Cloud Hospital, St. Cloud, MN, USA.
J Interv Card Electrophysiol. 2019 Mar;54(2):93-100. doi: 10.1007/s10840-018-0444-x. Epub 2018 Sep 27.
Persistent left superior vena cava (PLSVC) is one of the most frequently reported congenital anomalies and may be an important source of trigger of atrial fibrillation (AF).
This was a multicenter retrospective experience including 28 patients with PLSVC who were referred for catheter ablation for drug-refractory symptomatic AF. Pulmonary vein and PLSVC isolation were performed (3.5-mm open irrigated tip ablation catheter at maximum power of 20 W, maximum temperature 43 °C with flow rate of 17 ml/min). Clinical outcomes such as complications and long-term freedom from AF were measured.
The mean age of the population was 61 ± 8 years, 21% were females, and AF duration was 60 ± 33 months. Sixty-one percent paroxysmal AF (17/28), 25% (7/28) persistent AF, and 14% (4/28) had long-standing persistent AF. There were no major complications that required any intervention. PLSVC isolation was achieved in 96% (27/28). Freedom from AF at 1 year without antiarrhythmic drugs was seen in 75% (21/28) of patients.
In PLSVC patients with AF, segmental isolation of PLSVC appears to be feasible and safe and can translate into favorable clinical outcomes.
永存左上腔静脉（PLSVC）是最常报道的先天性异常之一，可能是心房颤动（AF）的一个重要触发源。
这是一项多中心回顾性研究，纳入28例因药物难治性症状性AF接受导管消融治疗的PLSVC患者。进行肺静脉和PLSVC隔离（使用3.5毫米开放式灌注尖端消融导管，最大功率20瓦，最高温度43°C，流速17毫升/分钟）。测量并发症和AF长期缓解等临床结局。
研究人群的平均年龄为61±8岁，女性占21%，AF病程为60±33个月。61%为阵发性AF（17/28），25%（7/28）为持续性AF，14%（4/28）为长期持续性AF。没有需要任何干预的重大并发症。96%（27/28）实现了PLSVC隔离。75%（21/28）的患者在1年时未使用抗心律失常药物即实现AF缓解。
在患有AF的PLSVC患者中，PLSVC节段性隔离似乎可行且安全，并可转化为良好的临床结局。
