Impact of High-Dose Isoproterenol on Provocation of Atrial Fibrillation Originating from the Superior Vena Cava

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Introduction: The superior vena cava (SVC) is the major focus for initiating non pulmonary vein (PV) atrial fibrillation (AF). However, the method of provocation of AF from SVC is not well defined. The purpose of this study was to investigate utility of the high-dose isoproterenol on provocation of AF from SVC. Methods: This study included 84 patients (69 men, mean age 57±10 years) with paroxysmal AF. All patients were evaluated the arrhythmogenic foci with atrial pacing and isoproterenol (1–2 µg/min) infusion to rule out non-PV foci. After Extensive encircling pulmonary vein isolation (EEPVI) and focal ablation of arrhythmogenic foci, high-dose isoproterenol was infused at 5 µg/min for 5 minutes for unmasking latent SVC firing. If SVC focus was identified, the isolation of SVC was performed. Results: Eighty-two patients in 84 patients were performed EEPVI. The remaining 2 patients were performed only focal ablation for non-PV focus (crista terminalis, coronary sinus ostium). After EEPVI of 82 patients, SVC focus was revealed in 16 patients (20%) with high-dose isoproterenol and performed SVC isolation. At a mean follow-up of 14±11 months, sinus rhythm was maintained without any antiarrhythmics in 74 patients (88%). Conclusions: The high-dose isoproterenol could identify the SVC focus of paroxysmal AF. Even if EEPVI is performed completely, the high-dose isoproterenol should be tried to avoid the recurrence of AF from SVC.