Small Left Atrial Diameter Is a Predictor of Ectopy from Superior Vena Cava in Patients with Atrial Fibrillation

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Background: Non-pulmonary vein foci of atrial fibrillation (AF) are one of the causes of recurrence after pulmonary vein isolation. Ectopy from superior vena cava (SVC) is frequently seen, and it is treatable by SVC isolation. We investigated pre-procedure predictors of SVC ectopy. Methods: Consequent 102 patients (age 61±12 years, paroxysmal AF 83%) who underwent ablation of AF were enrolled. After pulmonary vein isolation (isolation of all 4 pulmonary veins), we induced supra-ventricular ectopies initiating AF by infusion of isoproterenol (2–5 µg/min) and identified their originating sites. If ectopies were not induced, we used atrial burst pacing to induce AF and observed spontaneous ectopies after cardioversion. Results: SVC ectopy was induced in 9 (9%) of patients. Patients with SVC ectopy were younger than those without SVC ectopy (53±16 vs. 62±11 years, p=0.043). Left atrial diameter (LAD) was smaller (36±5 vs. 42±6 mm, p=0.001), and CHADS2 score was lower (0.22±0.44 vs. 0.89±0.77, p=0.012) in patients with SVC ectopy. Multiple logistic regression analysis including age, LAD and CHADS2 score was conducted. It revealed that LAD (mm) was the only predictor of SVC ectopy (odds ratio 0.81, 95%CI 0.69–0.96, p=0.014). Conclusion: Small LAD is a predictor of SVC ectopy. Patients with relatively small left atrial size should be screened for SVC ectopy in ablation of AF.