Elimination of atrial fibrillation trigger from superior vena cava using a circular pulsed field ablation catheter

Sep 29, 2026

Limited evidence exists on the efficacy and safety of pulsed field ablation (PFA) for the superior vena cava (SVC). This report describes the first case of incessant recurrent atrial fibrillation (IRAF) originating from the distal SVC successfully treated with circular PFA. Four PFA applications just below the firing site immediately abolished IRAF, confirmed by high-resolution mapping, and achieved SVC isolation at the catheter level with precise venographic contact. The approach supports accurate catheter positioning and isolation-line prediction for safe, effective SVC isolation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

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Summary

Case description

Mapping and identification of the SVC trigger

PFA delivery and SVC isolation

Follow-up and safety outcomes

Figure 1 description

Disclosures and data availability

European Heart Journal-Case Reports (2026) 10, ytaf637 [https://doi.org/10.1093/ehjcr/ytaf637](https://doi.org/10.1093/ehjcr/ytaf637) IMAGES IN CARDIOLOGY Electrophysiology Elimination of atrial fibrillation trigger from superior vena cava using a circular pulsed field ablation catheter Seigo Yamashita 1*, Kosuke Minai1, Michifumi Tokuda 2, and Teiichi Yamane2 1Division of Cardiology, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo 125-8506, Japan; and 2Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo 105-8471, Japan Received 8 July 2025; revised 11 November 2025; accepted 8 December 2025; online publish-ahead-of-print 11 December 2025 ESC curriculum 5.3 Atrial fibrillation • 5.5 Supraventricular tachycardia Summary There was limited evidence regarding the efficacy and safety of pulsed field ablation (PFA) for the superior vena cava (SVC) .1,2 We report the first case of incessant recurrent atrial fibrillation (IRAF) originating from the distal SVC, which could be successfully treated using circular PFA. Four PFA applications just below the firing site immediately eliminated IRAF, with high-resolution mapping confirming cessation of firing and SVC isolation at the PFA catheter level. Our approach enables us to accurately identify the PFA catheter position within the SVC and confirm good tissue contact with the SVC via venography. Together, the accurate prediction of the isolation line using bipolar pulses between circular electrodes may facilitate safe and effective SVC isolation. Case description A 61-year-old man underwent catheter ablation for paroxysmal atrial fibrillation (AF) using a circular pulsed field ablation (PFA) catheter (PulseSelectTM, Medtronic, Minneapolis, MN, USA) . Following the insertion of the PFA catheter into the left atrium, incessant recurrent AF (IRAF) was induced. The detailed mapping revealed the trigger from the superior vena cava (SVC), with very rapid myocardial firing (cycle length: 100 ms) at a localized area on the anterolateral aspect of the distal SVC. The activation spread outwards with conduction block (Figure 1A) . After positioning the PFA catheter (array diameter: 25 mm) below the SVC firing site and confirming good contact by venography (Figure 1C), we delivered four biphasic, bipolar pulse trains. This application immediately eliminated IRAF and achieved SVC isolation (Figure 1B) . The SVC was isolated at precisely at the same level where the PFA catheter was positioned, as evidenced by a welldemarcated low-voltage area boundary (Figure 1D). We thereafter successfully performed pulmonary vein isolation using PFA and completed the procedure after confirming the absence of PV/SVC reconnection and non-PV foci under administration of isoproterenol and adenosine. No sinus node or phrenic nerve injury was observed, and no atrial arrhythmia recurred during the 9-month follow-up. * Corresponding author. Tel: +81 3 3603 2111, Email: [seigoy722@yahoo.co.jp](seigoy722@yahoo.co.jp)[ ](seigoy722@yahoo.co.jp)Handling Editor: Felix Wiedmann Peer-reviewers: Ahmad Altom; Martin Manninger © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. Figure 1 (A) Initiation of very rapid firings (cycle length: 100 ms) from the limited small area at the anterolateral location was detected at a spline of OrionTM catheter (arrow) . The other splines and pulsed field ablation catheter in the superior vena cava showed slow activity (dotted box) . (B) Incessant recurrent atrial fibrillat

FAQs

What arrhythmia trigger was targeted in this case?

The case targeted a trigger originating from the distal superior vena cava (SVC) causing incessant recurrent atrial fibrillation (IRAF). High-resolution mapping localized very rapid myocardial firing to a small anterolateral area of the distal SVC.

How was pulsed field ablation (PFA) delivered and what was the immediate result?

After positioning the circular PFA catheter below the SVC firing site and confirming contact by venography, four biphasic bipolar pulse-train applications were delivered. IRAF disappeared immediately and SVC isolation was achieved at the same catheter level.

What evidence confirmed successful SVC isolation?

Mapping showed cessation of firing and a well-demarcated boundary of a low-voltage area. The SVC was isolated precisely at the catheter position level, with reconfirmation that there was no PV/SVC reconnection and no non-PV foci under isoproterenol and adenosine.

Sep 29, 2026

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