Structural characteristics of patients with superior vena cava foci initiating atrial fibrillation: Analysis with electrocardiogram‐triggered computed tomography. (5th February 2023)

• Record Type: Journal Article
• Authors: Oka, Satoshi; Yamagata, Kenichiro; Nishii, Tatsuya; Tonegawa‐Kuji, Reina; Shimamoto, Keiko; Inoue, Yuko; Miyamoto, Koji; Nagase, Satoshi; Aiba, Takeshi; Kusano, Kengo
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 34:Number 3(2023)
• Page Start: 556
• Page End: 564
• Publication Date: 2023-02-05
• Subjects: atrial fibrillation -- catheter ablation -- right atrial dilatation -- superior vena cava crescent sign -- superior vena cava ectopic beats; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.15825
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: Introduction: The superior vena cava (SVC) is the most common source of non‐pulmonary vein foci in atrial fibrillation (AF); therefore, predicting the existence of non‐pulmonary vein foci before the catheter ablation procedure helps construct a proper ablation strategy in preparation for SVC isolation. This study aimed to clarify the structural characteristics of patients with SVC foci initiating AF. Methods: We enrolled 331 consecutive patients with AF who underwent cardiac computed tomography imaging before radiofrequency catheter ablation treatment, and they were divided into SVC (+) and (−) groups based on the presence or absence of SVC foci initiating AF. Results: The SVC (+) group ( n = 27) exhibited SVC crescent signs—defined as a curve‐shaped SVC with two narrow pointed ends—more frequently (37% vs. 9%, p < .001), and larger right atrial volume (95.6 ± 20.8 vs. 80.5 ± 26.1 mL, p = .004) than the SVC (−) group ( n = 304). Multivariate logistic regression analysis revealed that the SVC crescent sign (odds ratio, 8.88; 95% confidence interval [CI], 3.21–24.60) and right atrial volume (odds ratio, 1.03; 95% CI, 1.01–1.04) were independent predictors of SVC foci. Conclusion: Patients with SVC foci exhibited more frequent SVC crescent signs and larger right atrial volumes, and these characteristics may help clinicians choose the appropriate ablation technology. Abstract : Few studies have investigated the relationship between the anatomical characteristics and superior vena cava (SVC) ectopic beats that initiate atrial fibrillation (AF).This is the first study to evaluate the SVC crescent sign, defined as a curve‐shaped‐SVC with two narrow pointed ends resembling the moon, as the specific morphology of patients whose SVC initiates AF. Patients with SVC ectopic beats initiating AF had more frequent SVC crescent signs and larger right atrial volume; these findings may help clinicians plan the ablation strategy in advance of the procedure.