Pulsed-field-ablation for the treatment of atrial fibrillation in patients with congenital anomalies of cardiac veins

J Cardiovasc Electrophysiol. 2023 May;34(5):1183-1191. doi: 10.1111/jce.15900. Epub 2023 Apr 26.


Introduction: Anomalous cardiac veins are not rare and pulmonary vein (PV) isolation for atrial fibrillation (AF) treatment should include these veins. Pulsed-field ablation (PFA) is a novel technology for AF ablation with excellent efficacy and safety profile. In this case series, we describe our first experience of isolation of anomalous cardiac veins using PFA in patients with AF.

Methods: We report a series of patients with congenital anomalies of the cardiac veins and AF, treated with PFA. All patients underwent cardiac computed tomography for procedural planning.

Results: We included five patients (four males). Anomalous cardiac veins included a connection of a left common ostium to the coronary sinus, a partial and complete drainage of the right superior PV into the superior vena cava (SVC) with and without additional atrial septal defect, a persistent left SVC and an anomalous posterior PV. All anomalous PVs were isolated using PFA. No phrenic nerve palsy or other complications occurred. PFA of an abnormal right superior PV draining into the distal SVC was possible without affecting the sinus node. After a median of 4 months, four patients were free of recurrence. One patient had recurrent AF and perimitral reentry tachycardia, probably facilitated by PFA in the mitral isthmus region during isolation of an anomalous connection of the left common ostium to the coronary sinus.

Conclusions: Using systematic preprocedural imaging and three-dimensional-electroanatomic mapping, the currently available PFA system seems well suited, efficient, and versatile for the treatment of AF in patients with anomalous cardiac veins.

Keywords: anomalous cardiac veins; atrial fibrillation; persistent left superior vena cava; pulsed-field ablation; unroofed coronary sinus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / diagnostic imaging
  • Catheter Ablation* / adverse effects
  • Heart
  • Humans
  • Male
  • Persistent Left Superior Vena Cava*
  • Pulmonary Veins* / diagnostic imaging
  • Pulmonary Veins* / surgery
  • Treatment Outcome
  • Vena Cava, Superior / diagnostic imaging
  • Vena Cava, Superior / surgery