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Superior Vena Cava (superior + vena_cava)

Distribution by Scientific Domains

Medical Sciences	94%
Life Sciences	3%

Distribution within Medical Sciences

Cardiovascular Disease	75%
Anesthesia & Pain Management	8%
5 Other Subdomains	17%

Terms modified by Superior Vena Cava

superior vena cava syndrome

Selected Abstracts

Persistent Left-Sided Superior Vena Cava: Integrated Noninvasive Diagnosis

ECHOCARDIOGRAPHY, Issue 9 2007
Antonino Recupero M.D.
Persistent left superior vena cava (PLSVC) is a rare finding. We describe 5 patients with PLSVC diagnosed by a noninvasive approach, including two-dimensional (2D) echocardiogram, nuclear magnetic resonance and multislice computed tomography (MCT). In 4 cases the PLSVC was isolated ("alone PLSVC"), and in 1 case associated with a right superior vena cava. [source]

Successful Surgical Correction of a Single Atrium Associated with Cleft Mitral Valve Persistent Left Superior Vena Cava and Pulmonary Valvular Stenosis as an Isolated Cardiac Defect

JOURNAL OF CARDIAC SURGERY, Issue 3 2005
Akin Izgi M.D.
It is extremely rare for SA to be observed as an isolated defect. We report here a 13-year-old male patient with SA as an isolated cardiac defect, successfully corrected by surgery. [source]

Impact of Systematic Isolation of Superior Vena Cava in Addition to Pulmonary Vein Antrum Isolation on the Outcome of Paroxysmal, Persistent, and Permanent Atrial Fibrillation Ablation: Results from a Randomized Study

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2010
ANDREA CORRADO M.D.
Impact of the Systematic Isolation of the Superior Vena Cava.,Background: Pulmonary veins (PVs) have been shown to represent the most frequent sites of ectopic beats initiating paroxysmal atrial fibrillation (AF). However, additional non-PV triggers, arising from different areas, have been reported as well. One of the most common non-PV sites described is the superior vena cava. Aims: The purpose of the study was to investigate the impact resulting from the systematic isolation of the superior vena cava (SVCI) in addition to pulmonary vein antrum isolation (PVAI) on the outcome of paroxysmal, persistent, and permanent AF ablation. Methods: A total of 320 consecutive patients who had been referred to our center in order to undergo a first attempt of AF ablation were randomized into 2 groups. Group I (160 patients) underwent PVAI only; Group II (160 patients) underwent PVAI and SVCI. Results: AF was paroxysmal in 134 (46%), persistent in 75 (23%), and permanent in 111 (31%) of said patients. SVCI was performed on 134 of the 160 patients (84%) in Group II. SVC isolation was not performed on the remaining 26 patients either because of phrenic nerve capture or the lack of SVC potentials. Comparison of the outcome data between the 2 groups, after a follow-up of 12 months, revealed a significant difference in total procedural success solely with patients manifesting paroxysmal atrial fibrillation (56/73 [77%] Group I vs. 55/61 [90%] Group II; P = 0.04; OR 2.78). Conclusions: In our study, the strategy of the empiric SVCI in addition to PVAI has improved the outcome of AF ablation solely in patients manifesting paroxysmal AF. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1,5, January 2010) [source]

Usefulness of Interatrial Conduction Time to Distinguish Between Focal Atrial Tachyarrhythmias Originating from the Superior Vena Cava and the Right Superior Pulmonary Vein

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2008
KUAN-CHENG CHANG M.D.
Objective: Differentiation of the tachycardia originating from the superior vena cava (SVC) or the right superior pulmonary vein (RSPV) is limited by the similar surface P-wave morphology and intraatrial activation pattern during tachycardia. We sought to find a simple method to distinguish between the two tachycardias by analyzing the interatrial conduction time. Methods: Sixteen consecutive patients consisting of 8 with SVC tachycardia and the other 8 with RSPV tachycardia were studied. The interatrial conduction time from the high right atrium (HRA) to the distal coronary sinus (DCS) and the intraatrial conduction time from the HRA to the atrial electrogram at the His bundle region (HIS) were measured during the sinus beat (SR) and during the tachycardia-triggering ectopic atrial premature beat (APB). The differences of interatrial (,[HRA-DCS]SR-APB) and intraatrial (,[HRA-HIS]SR-APB) conduction time between SR and APB were then obtained. Results: The mean ,[HRA-DCS]SR-APB was 1.0 ± 5.2 ms (95% confident interval [CI],3.3,5.3 ms) in SVC tachycardia and 38.5 ± 8.8 ms (95% CI 31.1,45.9 ms) in RSPV tachycardia. The mean ,[HRA-HIS]SR-APB was 1.5 ± 5.3 ms (95% CI ,2.9,5.9 ms) in SVC tachycardia and 19.9 ± 12.0 ms (95% CI 9.9,29.9 ms) in RSPV tachycardia. The difference of ,[HRA-DCS]SR-APB between SVC and RSPV tachycardias was wider than that of ,[HRA-HIS]SR-APB (37.5 ± 9.3 ms vs. 18.4 ± 15.4 ms, P < 0.01). Conclusions: The wide difference of the interatrial conduction time ,[HRA-DCS]SR-APB between SVC and RSPV tachycardias is a useful parameter to distinguish the two tachycardias and may avoid unnecessary atrial transseptal puncture. [source]

Electrical Disconnection of the Superior Vena Cava from the Right Atrium

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2004
VINOD K. JAYAM M.D.
[source]

High-Resolution Mapping of Tachycardia Originating from the Superior Vena Cava: Evidence of Electrical Heterogeneity, Slow Conduction, and Possible Circus Movement Reentry

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2002
DIPEN C. SHAH M.D.
Superior Vena Cava Reentry. High-resolution mapping of a tachycardia originating from the superior vena cava (SVC) in a patient with atrial fibrillation is described. Unidirectional circuitous repetitive activation encompassing the full tachycardia cycle length was documented around a line of block within the myocardial sleeve of the SVC. Intermittent conduction to the right atrium resulted in an irregular atrial tachycardia. Evidence of electrical heterogeneity and slow conduction persisted in sinus rhythm and was exaggerated by premature stimulation but did not reproduce the activation pattern during tachycardia. All the available evidence is best compatible with circus movement reentry within the SVC, with marked slow and anisotropic conduction responsible for the restricted dimensions of the reentrant circuit. These findings may suggest a similar substrate and arrhythmia mechanism in the myocardium of the pulmonary veins. [source]

Focal Atrial Tachycardia Originating from the Donor Superior Vena Cava after Bicaval Orthotopic Heart Transplantation

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2010
HAW-KWEI HWANG M.D.
An 11-year-old boy, who underwent bicaval orthotopic heart transplantation for idiopathic dilated cardiomyopathy, had a focal atrial tachycardia originating from the donor superior vena cava. The pathogenesis of this tachycardia may be related to transplant rejection or transplant vasculopathy. Radiofrequency catheter ablation can eliminate this unique tachycardia and result in hemodynamic improvement. (PACE 2010; e68,e71) [source]

Atrioventricular Nodal Tachycardia in a Patient with Anomalous Inferior Vena Cava with Azygos Continuation and Persistent Left Superior Vena Cava

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2009
MIGUEL A. ARIAS M.D., Ph.D.
A 39-year-old female patient was referred for ablation of recurrent episodes of atrioventricular nodal reentrant tachycardia. A combination of an anomalous inferior vena cava with azygos continuation and a persistent left superior vena cava was discovered. A nonfluoroscopic navigation system was very useful for catheter ablation of the tachycardia in this unusual case of anomalous venous system of the heart. [source]

Implant of a Biventricular Pacemaker in a Patient with Dextrocardia and Persistent Left Superior Vena Cava

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2006
CHRISTIAN POTT
Congenital anomalies of the heart can pose challenges to cardiac invasive procedures. Here, we present the case of a 40-year-old man with the combination of dextrocardia, a persistent left superior vena cava, and idiopathic dilated cardiomyopathy. We describe the successful implantation of a biventricular pacemaker,defibrillator under this complex anatomic condition. [source]

Percutaneous Treatment for Pacemaker-Associated Superior Vena Cava Syndrome

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2002
ALBERT W. CHAN
CHAN, A.W., et al.:Percutaneous Treatment for Pacemaker-Associated Superior Vena Cava Syndrome. Superior vena cava (SVC) obstruction is an uncommon but serious complication associated with permanent pacemaker implantation. The mechanical stress associated with pacemaker wires may lead to vessel wall inflammation, fibrosis, and thrombus formation, and ultimately to venous stenosis and occlusion. The surgical treatment of pacemaker related SVC syndrome requires thoracotomy and carries significant morbidity. This article illustrates the authors' initial experience with a "one-step" percutaneous approach for this problem, consisting of percutaneous retrieval of a pacemaker system, followed by venous revascularization with angioplasty and stenting, and installation of a new pacemaker device. [source]

Cerebral tissue oxygenation index and superior vena cava blood flow in the very low birth weight infant

ACTA PAEDIATRICA, Issue 1 2009
M Moran
Abstract Background: Superior vena cava (SVC) flow assesses blood flow from the upper body, including the brain. Near infrared spectroscopy (NIRS) provides information on brain perfusion and oxygenation. Aim: To assess the relationship between cerebral tissue oxygenation index (cTOI) and cardiac output measures in the very low birth weight (VLBW) infant in the first day of life. Methods: A prospective observational cohort study. Neonates with birth weight less than 1500 g (VLBW) were eligible for enrollment. Newborns with congenital heart disease, major congenital malformations and greater than Papile grade1 Intraventricular Haemorrhage on day 1 of life were excluded. Echocardiographic evaluation of SVC flow was performed in the first 24 h of life. Low SVC flow states were defined as a flow less than 40 mL/kg/min. cTOI was measured using NIRO 200 Hamamatsu. Results: Twenty-seven VLBW neonates had both echocardiography and NIRS performed. The median (range) gestation was 29/40 (25 + 3 to 31 + 5 weeks) and median birth weight was 1.2 kg (0.57,1.48 kg). The mean (SD) TOI was 68.1 (7.9)%. The mean (SD) SVC flow was 70.36(39.5) mLs/kg/min. The correlation coefficient of cerebral tissue oxygenation and SVC flow was r = 0.53, p-value 0.005. There was a poor correlation between right and left ventricular output and cTOI which is not surprising considering the influence of intra- and extracardiac shunts. Conclusion: There is a positive relationship between cerebral TOI values and SVC flow in the very low birth infant on day one of life. [source]

Anomalous Left Anterior Descending Coronary Artery from the Pulmonary Artery, Unroofed Coronary Sinus, Patent Foramen Ovale, and a Persistent Left-sided SVC in a Single Patient: A Harmonious Quartet of Defects

CONGENITAL HEART DISEASE, Issue 2 2009
Andrew J. Klein MD
ABSTRACT Unroofing of the coronary sinus without complex structural heart defects is a rare congenital defect often seen in conjunction with a persistent left-sided superior vena cava. Anomalous origin of the left anterior descending artery from the pulmonary artery with normal origin of the left circumflex coronary artery is an even rarer congenital cardiac defect. We report a case of a 54-year-old woman presenting with mild dyspnea on exertion who was found on invasive and noninvasive evaluations to have a unique combination of defects,unroofed coronary sinus, persistent left-sided superior vena cava, patent foramen ovale, and anomalous origin of the left anterior descending artery from the pulmonary artery without evidence of previous coronary ischemia. [source]

Hemiazygos Venous Additional Pulmonary Flow for Successful Total Cavo-pulmonary Connection

CONGENITAL HEART DISEASE, Issue 5 2007
Koichi Sughimoto MD
ABSTRACT Patients who underwent only Glenn procedure after being deemed unsuitable candidates for Fontan completion are not small in number, and may develop arterio-venous (AV) pulmonary malformations during the follow-up period. We present the case of a 17-year-old woman with severe systemic desaturation 13 years after Glenn procedure and repair of total anomalous pulmonary venous return. Among other anomalies, the patient disclosed hemiazygos continuation to a persistent left superior vena cava. This case supports the concept that returning flow from the abdominal vein plays an important role in the well-balanced growth of the pulmonary artery and in the inhibition of the pulmonary AV malformation. [source]

Neonatal Congestive Heart Failure Due to a Subclavian Artery to Subclavian Vein Fistula Diagnosed by Noninvasive Procedures

CONGENITAL HEART DISEASE, Issue 3 2006
Gregory H. Tatum MD
ABSTRACT Congestive heart failure in the neonate is usually due to intracardiac anomalies or cardiac dysfunction. Extracardiac causes are rare. Patient., We report a newborn infant who presented with respiratory distress and cardiomegaly. Result., Echocardiography identified a dilated right subclavian artery and vein and superior vena cava. Magnetic resonance imaging confirmed a subclavian artery to subclavian vein fistula that was treated with surgical ligation. The infant recovered fully. This case underscores the need for clinical suspicion of fistulous connection in unusual locations in the face of unexplained heart failure in the neonate. Conclusion., Echocardiographic and magnetic resonance imaging are effective noninvasive modalities to confirm the diagnosis prior to surgical intervention. [source]

Doppler Superior Vena Cava Flow Evolution and Respiratory Variation in Superior Vena Cava Syndrome

ECHOCARDIOGRAPHY, Issue 4 2008
Fa Qin Lv M.D.
Background: Superior vena cava syndrome (SVCS) is a clinical expression of obstruction of blood flow through the superior vena cava. The patterns of the Doppler flow changes of superior vena cava (SVC), especially the respiratory effects on them have not yet been fully elucidated. This study was to examine SVC Doppler flow patterns and the respiratory effects on them in healthy subjects and patients with SVCS. Methods: The SVC Doppler flow patterns of 18 normal human subjects and 22 patients with SVCS were analyzed at initial diagnosis and were followed up every 2 months for at least 11 months. Results: Among the 22 patients, 5 patients with the tumor near the right atrium oppressing the inferior segment of the SVC had clear VR- and AR-waves, while in the other 17 patients the VR- and AR-waves disappeared or their outlines were vague. The respiratory variations of the S- and D-waves as a percentage change in inspiration compared to expiration in patient group were much lower than those in control group (S-wave: 1.67 ± 3.32% vs. 15.65 ± 16.15%, P = 0.0003; D-wave: 1.80 ± 1.12% vs. 23.55 ± 37%, P = 0.0087), which gradually became larger with treatment and showed no significant difference with those in control group after 7 months. Conclusions: The Doppler flows of the patients with SVCS correlate well with the images of CT scan of them. The respiratory variation of the S- and D-velocities could be used to evaluate the severity of SVC obstruction and its therapeutic effect. [source]

Persistent Left-Sided Superior Vena Cava: Integrated Noninvasive Diagnosis

Right Coronary Artery Hepatic Vein Fistula: A Case Report

ECHOCARDIOGRAPHY, Issue 10 2006
Sevket Gorgulu M.D.
There is a slight predominance for coronary artery fistulas that involve the right coronary artery, while multiple fistulas have also been reported. The usual site of termination is one or more of the low-pressure structures in the heart or the great vessels such as the right or left atria, right ventricle, coronary sinus, pulmonary artery, or superior vena cava. However, a coronary fistula that drains into a hepatic vein has not been reported in the literature. Therefore, this is the first case report indicating a right coronary artery fistula that drains into the middle hepatic vein. [source]

Fibrosing TB Mediastinitis Presenting as a Superior Vena Cava Syndrome: A Case Presentation and Echocardiogram Correlate

ECHOCARDIOGRAPHY, Issue 7 2006
Lidiette Esquivel M.D.
A 49-year-old woman developed a chronic obstruction of the superior vena cava (SVC) as a complication of mediastinal tuberculosis. Echocardiography findings are presented along with the cavography. Symptoms disappeared after stenting the fibrosed SVC. Transesophageal echocardiogram findings led to the condition's final resolution. [source]

Catheter-related septic thrombosis of superior vena cava and right heart in a patient with active Crohn's disease

INFLAMMATORY BOWEL DISEASES, Issue 12 2008
J.S. Souza MD
No abstract is available for this article. [source]

An investigation of pulsatile flow in a model cavo-pulmonary vascular system

INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING, Issue 11 2009
K. Chitra
Abstract The complexities in the flow pattern in a cavo-pulmonary vascular system,after application of the Fontan procedure in the vicinity of the superior vena cava, inferior vena cava, and the confluence at the T-junction,are analysed. A characteristic-based split (CBS) finite element scheme involving the artificial compressibility approach is employed to compute the resulting flow. Benchmarking of the CBS scheme is carried out using standard problems and with the flow features observed in an experimental model with the help of a dye visualization technique in model scale. The transient flow variations in a total cavo-pulmonary connection (TCPC) under pulsatile conditions are investigated and compared with flow visualization studies. In addition to such qualitative flow investigations, quantitative analysis of energy loss and haemodynamic stresses have also been performed. The comparisons show good agreement between the numerical and experimental flow patterns. The numerically predicted shear stress values indicate that the pulsatile flow condition is likely to be more severe than steady flow, with regard to the long-term health of the surgically corrected TCPC. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Central venous oxygen saturation for the diagnosis of low cardiac output in septic shock patients

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010
A. PERNER
Background: Simple diagnostic tests are needed to screen septic patients for low cardiac output because intervention is recommended in these patients. We assessed the diagnostic value of central venous oxygen saturation in the superior vena cava (ScvO2) for detecting low cardiac output in patients with septic shock. Methods: We conducted a prospective observational study in three general intensive care units (ICUs) of adult patients with septic shock, who were to have a catheter inserted for thermodilution measurement of cardiac index (CITD). Paired measurements of CITD and central venous oximetry values were obtained when the clinician first measured CITD. Results: We included 56 patients with septic shock and a mean sequential organ failure assessment score of 12 (range 3,20). Baseline CITD was 3.5 l/min/m2 (1.0,6.2) and ScvO2 of 70% (33,87). The best cut-off of ScvO2 for CITD>2.5 l/min/m2 (n=42) was a value ,64% with positive and negative predictive values of 91% (95% confidence interval 79,98) and 91% (59,100), respectively. The diagnostic values were not improved by using instead central venous O2 tension or the difference between arterial and central venous O2 saturation. Conclusions: This prospective, observational study found that a ScvO2 measurement of ,64% indicated CITD>2.5 l/min/m2 in ICU patients with septic shock. [source]

Superior Vena Cava Syndrome post Minimally Invasive Mitral Valve Repair

JOURNAL OF CARDIAC SURGERY, Issue 2 2010
Turki B. Albacker M.D.
The tamponade was caused by local compression of junction between the right atrium and superior vena cava. This case illustrates the importance of using transesophageal echocardiogram in postoperative management of cardiac surgery patients.,(J Card Surg 2010;25:174-175) [source]

Robot-Assisted Isolation of the Pulmonary Veins with Microwave Energy

JOURNAL OF CARDIAC SURGERY, Issue 1 2006
F.A.C.S., J. Michael Smith M.D.
This study evaluated the feasibility of performing a minimally invasive left atrial isolation on a beating heart using the da Vinci Robotic Surgical System and a flexible microwave probe (Flex 10 by AFx, Inc., Fremont, CA, USA), and the reliability of exit block pacing to confirm transmurality of the lesions created. Methods: On six canines, the Flex 10 probe was passed around the left atrium posterior to the superior vena cava, through the transverse sinus, and back through the oblique sinus via a right-chest-only approach using the da Vinci Robotic Surgical System. Prior to ablation, pacing outside the atrial cuff was confirmed. Ablation was then carried out on the beating heart and repeated (as needed) until electrical isolation was demonstrated by exit block pacing. Probe position was confirmed at the completion of the procedure via sternotomy. Analysis included acute histologic and gross examination of the targeted area. Results: There was no significant difference (p = 0.110) in procedure time, although it decreased 39.6% from the first three cases to the last three cases. Electrical evidence of electrical left atrial isolation was achieved in all subjects. Acute histologic examination confirmed transmurality inconsistently. Additionally, in two animals, the Flex 10 probe was found to be anterior to the left atrial appendage. All animals survived the procedure. Conclusion: A minimally invasive left atrial isolation procedure using monopolar microwave energy with the da Vinci Robotic Surgical System is simple and feasible. However, despite creating an electrical block, transmurality was not demonstrated consistently and further confirmation of catheter positioning is necessary during a right-chest-only approach. [source]

Left Superior Vena Cava Draining into the Left Atrium, Associated with Partial Anomalous Pulmonary Venous Connection: Surgical Correction

JOURNAL OF CARDIAC SURGERY, Issue 4 2005
Andrea Quarti M.D.
Although intra-atrial rerouting techniques, in patients with no connecting vein, have proved to be reliable and successful, in many cases the extracardiac repair is preferable. We report a case of a 5-month-old patient with a not connected left superior vena cava draining into the left atrium, associated with atrial septal defect and partial anomalous pulmonary venous connection. The correction has been achieved by rerouting the pulmonary venous return into the left atrium and by transposition of the left vena cava on the right appendage. [source]

Partial Anomalous Pulmonary Venous Connection: Correction by Intra-atrial Baffle and Cavo-atrial Anastomosis

JOURNAL OF CARDIAC SURGERY, Issue 2 2002
O. Baron M.D.
An intra-atrial baffle, combined with cavo-atrial anastomosis, has been proposed to avoid these complications. The authors report their recent experience with this operative technique. From January 1997 to December 2000, 7 patients with a mean age of 13.5 ± 9 (2,31) years were operated according to this technique. Only one child did not have an associated atrial septal defect. The mean number of pulmonary veins connected to the superior vena cava was 2.5 ± 0.5. The immediate postoperative course was uneventful for the seven patients. The mean follow-up was 20 ± 17 months. No patient developed arrhythmia or superior vena cava or pulmonary vein obstruction at echocardiography. This surgical technique appears to constitute an attractive alternative when pulmonary veins drain abnormally into the superior vena cava above the cavo-atrial junction. [source]

Impact of Systematic Isolation of Superior Vena Cava in Addition to Pulmonary Vein Antrum Isolation on the Outcome of Paroxysmal, Persistent, and Permanent Atrial Fibrillation Ablation: Results from a Randomized Study

Frequency Analysis of Atrial Electrograms Identifies Conduction Pathways from the Left to the Right Atrium During Atrial Fibrillation,Studies in Two Canine Models

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2009
KYUNGMOO RYU Ph.D.
Studies of atrial fibrillation (AF) have demonstrated that a stable rhythm of very short cycle length in the left atrium (LA) can cause fibrillatory conduction in the rest of the atria. We tested the hypothesis that fast Fourier transform (FFT) analysis of atrial electrograms (AEGs) during this AF will rapidly and reliably identify LA-to-right atrium (RA) conduction pathway(s) generated by the driver. Methods and Results: During induced atrial tachyarrhythmias in the canine sterile pericarditis and rapid ventricular pacing-induced congestive heart failure models, 380,404 AEGs were recorded simultaneously from epicardial electrodes on both atria. FFT analysis of AEGs during AF demonstrated a dominant frequency peak in the LA (driver), and multiple frequency peaks in parts of the LA and the most of the RA. Conduction pathways from the LA driver to the RA varied from study-to-study. They were identified by the presence of multiple frequency peaks with one of the frequency peaks at the same frequency as the driver, and traveled (1) inferior to the inferior vena cava (IVC); (2) between the superior vena cava and the right superior pulmonary vein (RSPV); (3) between the RSPV and the right inferior pulmonary vein (RIPV); (4) between the RIPV and the IVC; and (5) via Bachmann's bundle. Conduction pathways identified by FFT analysis corresponded to the conduction pathways found in classical sequence of activation mapping. Computation time for FFT analysis for each AF episode took less than 5 minutes. Conclusion: FFT analysis allowed rapid and reliable detection of the LA-to-RA conduction pathways in AF generated by a stable and rapid LA driver. [source]

Usefulness of Interatrial Conduction Time to Distinguish Between Focal Atrial Tachyarrhythmias Originating from the Superior Vena Cava and the Right Superior Pulmonary Vein

Anatomy and Physiology of the Right Interganglionic Nerve: Implications for the Pathophysiology of Inappropriate Sinus Tachycardia

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2008
JING ZHOU M.D.
Objective: To simulate inappropriate sinus tachycardia (IST) in experimental animals. Background: We recently found that epinephrine injected into the anterior right ganglionated plexi (ARGP) adjacent to the sinoatrial (SA) node induced an arrhythmia simulating IST. Methods: In 19 anesthetized dogs, via a right thoracotomy, the course of the interganglionic nerve (IGN) from the right stellate ganglion along the superior vena cava to the heart was delineated. High-frequency stimulation (HFS; 0.1 msec duration, 20 Hz, 4.5,9.3 V) was applied to IGN at the junction of innominate vein and SVC. Results: HFS of the IGN significantly increased the sinus rate (SR) (baseline: 156 ± 19 beats/minutes [bpm], 4.5 V: 191 ± 28 bpm*, 8.0 V: 207 ± 23 bpm*, 9.3 V: 216 ± 18 bpm*; *P < 0.01 compared to baseline) without significant changes in A-H interval or blood pressure. P-wave morphology, ice mapping, and noncontact mapping indicated that this tachycardia was sinus tachycardia. In 8 of 19 dogs, injecting hexamethonium (5 mg), a ganglionic blocker, into the ARGP attenuated the response elicited by IGN stimulation (baseline: 160 ± 21 bpm, 4.5 V: 172 ± 32 bpm, 8.0 V: 197 ± 32 bpm*, 9.3 V: 206 ± 26 bpm*; *P < 0.05 compared to baseline). In 19 of 19 animals, after formaldehyde injection into the ARGP, SR acceleration induced by IGN stimulation was markedly attenuated (baseline: 149 ± 17 bpm, 4.5 V: 151 ± 21 bpm, 8.0 V: 155 ± 23 bpm, 9.3 V: 167 ± 24 bpm*; *P < 0.05 compared to baseline). Conclusions: HFS of the IGN caused a selective and significant acceleration of the SR. A significant portion of IGN traverses the ARGP or synapses with the autonomic ganglia in the ARGP before en route to the SA node. Dysautonomia involving the IGN and/or ARGP may play an important role in IST. [source]

Electrophysiological Characteristics and Catheter Ablation in Patients with Paroxysmal Supraventricular Tachycardia and Paroxysmal Atrial Fibrillation

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2008
SHIH-LIN CHANG M.D.
Introduction: Paroxysmal supraventricular tachycardia (PSVT) is often associated with paroxysmal atrial fibrillation (AF). However, the relationship between PSVT and AF is still unclear. The aim of this study was to investigate the clinical and electrophysiological characteristics in patients with PSVT and AF, and to demonstrate the origin of the AF before the radiofrequency (RF) ablation of AF. Methods and Results: Four hundred and two consecutive patients with paroxysmal AF (338 had a pure PV foci and 64 had a non-PV foci) that underwent RF ablation were included. Twenty-one patients (10 females; mean age 47 ± 18 years) with both PSVT and AF were divided into two groups. Group 1 consisted of 14 patients with inducible atrioventricular nodal reentrant tachycardia (AVNRT) and AF. Group 2 consisted of seven patients with Wolff-Parkinson-White (WPW) syndrome and AF. Patients with non-PV foci of AF had a higher incidence of AVNRT than those with PV foci (11% vs. 2%, P = 0.003). Patients with AF and atypical AVNRT had a higher incidence of AF ectopy from the superior vena cava (SVC) than those with AF and typical AVNRT (86% vs. 14%, P = 0.03). Group 1 patients had smaller left atrial (LA) diameter (36 ± 3 vs. 41 ± 3 mm, P = 0.004) and higher incidence of an SVC origin of AF (50% vs. 0%, P = 0.047) than did those in Group 2. Conclusion: The SVC AF has a close relationship with AVNRT. The effect of atrial vulnerability and remodeling may differ between AVNRT and WPW syndrome. [source]