Pulmoner Venler İzole Saptanan Nüks Atriyal Fibrilasyon Hastasında Superior Vena Cava İzolasyonu: Bir Olgu Sunumu
Özet
Atriyal fibrilasyon (AF) kateter ablasyonu sonrasında gelişen nükslerin yönetiminde, pulmoner ven (PV) rekoneksiyonlarının yanı sıra PV dışı tetikleyici odakların belirlenmesi ve uygun şekilde izole edilmesi giderek artan önem kazanmaktadır. Bu olgu sunumunda, paroksismal AF nedeniyle daha önce radyofrekans kateter ablasyonu uygulanmış 66 yaşındaki kadın hastada redo işlem sırasında PV rekoneksiyonları saptanarak yeniden pulmoner ven izolasyonu gerçekleştirilmiştir. İşlem esnasında gözlenen non-sustained atriyal taşikardi ataklarının aktivasyon haritalamasında en erken atriyal aktivitenin superior vena cava (SVC) bölgesinde olduğu belirlenmiş ve başarılı SVC izolasyonu uygulanmıştır. Bu olgu, redo AF ablasyonlarında PV rekoneksiyonlarının tedavisinin yanı sıra, özellikle SVC olmak üzere PV dışı odakların değerlendirilmesi ve gerektiğinde izole edilmesinin aritmi kontrolü açısından önemli olduğunu göstermektedir.
In the management of recurrent atrial fibrillation (AF) following catheter ablation, identification and appropriate isolation of non-pulmonary vein (PV) triggers have become increasingly important in addition to the treatment of PV reconnections. We present the case of a 66-year-old woman with paroxysmal AF who had previously undergone radiofrequency catheter ablation. During the repeat procedure, PV reconnections were identified and repeat pulmonary vein isolation was successfully performed. Activation mapping of non-sustained atrial tachycardia episodes observed during the procedure demonstrated the earliest atrial activation within the superior vena cava (SVC). Subsequently, successful SVC isolation was achieved. This case highlights the importance of evaluating and, when indicated, isolating non-PV triggers, particularly those originating from the SVC, in addition to treating PV reconnections during repeat AF ablation procedures to achieve optimal arrhythmia control.
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