Kantenwein Verena, Telishevska Marta, Bourier Felix, Kottmaier Marc, Brkic Amir, Risse Elena, Popa Miruna, Lengauer Sarah, Kolb Christof, Deisenhofer Isabel, Hessling Gabriele, Reents Tilko
Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany.
Pacing Clin Electrophysiol. 2022 Mar;45(3):357-364. doi: 10.1111/pace.14446. Epub 2022 Jan 29.
In patients with persistent left superior vena cava (PLSVC) ablation procedures can be challenging. We sought to determine the feasibility and safety of left atrial ablations in patients with PLSVC, especially when PLSVC is unknown prior to the ablation procedure.
In this retrospective analysis 15 adult patients (mean age 64.6 ± 14.5 years, 53.3% male) with PLSVC undergoing 27 ablation procedures for atrial fibrillation or left atrial flutter were included. In 5 (33.3%) patients PLSVC was only discovered during the procedure. Transseptal puncture (TSP) was declared "difficult" by the ablating physician in 13 of 27 (48.2%) procedures and was not successfully completed in the first attempt in two patients with known PLSVC. Once TSP was successfully completed, all relevant structures were reached both during mapping and ablation in all procedures independent of whether PLSVC was known prior to the procedure. One major complication (3.7%) occurred in 27 procedures in a patient with known PLSVC. In the patients with unknown PLSVC no complication occurred.
In experienced hands, left atrial access and ablation in patients with PLSVC is feasible and safe, particularly with regard to patients in whom the PLSVC is unknown prior to the ablation procedure.
对于存在持续左上腔静脉（PLSVC）的患者，消融手术可能具有挑战性。我们旨在确定PLSVC患者进行左心房消融的可行性和安全性，尤其是在消融手术前PLSVC情况未知时。
在这项回顾性分析中，纳入了15例接受27次房颤或左房扑动消融手术的成年PLSVC患者（平均年龄64.6±14.5岁，男性占53.3%）。在5例（33.3%）患者中，PLSVC仅在手术过程中被发现。在27例手术中的13例（48.2%）中，消融医生宣布经房间隔穿刺（TSP）“困难”，2例已知PLSVC的患者首次尝试未成功完成TSP。一旦TSP成功完成，无论手术前PLSVC是否已知，在所有手术的标测和消融过程中均能到达所有相关结构。27例手术中有1例（3.7%）已知PLSVC的患者发生了1例主要并发症。在PLSVC情况未知的患者中未发生并发症。
在经验丰富的医生手中，PLSVC患者进行左心房通路建立和消融是可行且安全的，尤其是对于那些在消融手术前PLSVC情况未知的患者。
