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Atrial Fibrillation Arising From the Left Brachiocephalic Vein
Journal of the American College of Cardiology © 2012 by the American College of Cardiology Foundation Published by Elsevier Inc.
Vol. 59, No. 8, 2012 ISSN 0735-1097/$36.00 doi:10.1016/j.jacc.2011.07.055
IMAGES IN CARDIOLOGY
Atrial Fibrillation Arising From the Left Brachiocephalic Vein Shingo Maeda, MD,*† Yasuteru Yamauchi, MD,* Tohru Obayashi, MD,* Kenzo Hirao, MD, PHD,† Mitsuaki Isobe, MD, PHD† Tokyo, Japan
From the *Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan; and the †Department of Cardiovascular Medicine, Tokyo Medical and Dental University Graduate School, Tokyo, Japan. Manuscript received June 2, 2011; accepted July 15, 2011.
A
65-year-old man underwent catheter ablation for drug-resistant paroxysmal atrial fibrillation (AF). Three Lasso catheters were positioned in the upper superior vena cava (SVC), mid SVC, and right superior pulmonary vein (RSPV) (A). Rapid firing from the upper SVC was observed, and that rapid activity arising from the upper SVC conducted to the mid SVC with 2:1 exit block (B). The arrhythmogenic focus was located 8 cm above the SVC–right atrial (RA) junction (C). Moreover, electroanatomical voltage mapping revealed that the myocardial sleeve extended up into the left brachiocephalic vein, and the arrhythmogenic focus was situated at the ostium of the left brachiocephalic vein indicated by the asterisk (D). Histological studies have revealed that the human SVC contains atrial muscle fibers that are continuous and uninterrupted from the RA to the root of the azygos vein. This is the first case to our knowledge in which AF arose from the left brachiocephalic vein. LA ⫽ left atrium.
Vol. 59, No. 8, 2012 ISSN 0735-1097/$36.00 doi:10.1016/j.jacc.2011.07.055
IMAGES IN CARDIOLOGY
Atrial Fibrillation Arising From the Left Brachiocephalic Vein Shingo Maeda, MD,*† Yasuteru Yamauchi, MD,* Tohru Obayashi, MD,* Kenzo Hirao, MD, PHD,† Mitsuaki Isobe, MD, PHD† Tokyo, Japan
From the *Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan; and the †Department of Cardiovascular Medicine, Tokyo Medical and Dental University Graduate School, Tokyo, Japan. Manuscript received June 2, 2011; accepted July 15, 2011.
A
65-year-old man underwent catheter ablation for drug-resistant paroxysmal atrial fibrillation (AF). Three Lasso catheters were positioned in the upper superior vena cava (SVC), mid SVC, and right superior pulmonary vein (RSPV) (A). Rapid firing from the upper SVC was observed, and that rapid activity arising from the upper SVC conducted to the mid SVC with 2:1 exit block (B). The arrhythmogenic focus was located 8 cm above the SVC–right atrial (RA) junction (C). Moreover, electroanatomical voltage mapping revealed that the myocardial sleeve extended up into the left brachiocephalic vein, and the arrhythmogenic focus was situated at the ostium of the left brachiocephalic vein indicated by the asterisk (D). Histological studies have revealed that the human SVC contains atrial muscle fibers that are continuous and uninterrupted from the RA to the root of the azygos vein. This is the first case to our knowledge in which AF arose from the left brachiocephalic vein. LA ⫽ left atrium.