A Case of Focal Atrial Tachycardia Originating from the Superior Vena Cava in Patient with Intracerebral Hemorrhage

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A 56-year-old woman was hospitalized with intracerebral hemorrhage. One week after admission, the surface ECG exhibited supraventricular tachycardia with narrow QRS complex. The P-wave morphology of the tachycardia in leads I, II and aVF was positive and in leads III and V1 showed biphasic that resembled closely to sinus rhythm. The heart rate of the tachycardia was highly variable, ranging between 110 and 150 bpm. The activation map by a three-dimensional (3-D) mapping system (Ensite NavX) during the tachycardia demonstrated focal atrial tachycardia (AT) originating from the superior vena cava (SVC) and the earliest endocardial activation site was at the lower septal aspect of the SVC, about 1 cm above the right atrium-SVC junction. A QS morphology of the unipolar electrogram at successful ablation site was found and AT cycle length accelerated transiently during application of ablation. The activation map during sinus rhythm revealed the approximate location of the sinus node region, laterally at the right atrium-SVC junction after the termination of AT. In conclusion, ablation therapy guided by a 3-D mapping system and unipolar electrogram at the target site of ablation are safe and highly effective in eliminating the focal AT originating the SVC without sinus node injury.