Swallow-induced syncope: A case report of atrial tachycardia originating from the SVC Tiffany Y. Hu, BS, Suraj Kapa, MD, FHRS, Yong-Mei Cha, MD, FHRS,

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Presentation transcript:

Swallow-induced syncope: A case report of atrial tachycardia originating from the SVC Tiffany Y. Hu, BS, Suraj Kapa, MD, FHRS, Yong-Mei Cha, MD, FHRS, Samuel J. Asirvatham, MD, FHRS, Malini Madhavan, MBBS HeartRhythm Case Reports Volume 2, Issue 1, Pages 83-87 (January 2016) DOI: 10.1016/j.hrcr.2015.11.004 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Holter monitor showing correlation between narrow complex tachycardia, swallowing, and syncope. HeartRhythm Case Reports 2016 2, 83-87DOI: (10.1016/j.hrcr.2015.11.004) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Electrophysiology study findings. A: Circular mapping catheter (Ls) in the right superior pulmonary vein (RSPV). The first beat is a sinus beat followed by the premature atrial complex (PAC). The RSPV recorded early far-field atrial electrograms (arrow) followed by recording of pulmonary vein potential (arrowhead) during the PAC. This is suggestive of origin of tachycardia in an adjacent chamber—in this case, the right atrium (RA) or the superior vena cava (SVC). B: Circular mapping catheter (Ls) in the SVC. The first beat is a sinus beat showing 2 sets of signals on the Ls catheter. In order to determine the origin of these signals, pacing is performed from the high RA using the ABL catheter (second beat). The first set of signals (arrow) are “pulled into” the pacing spike with capture of the RA, demonstrating that this represents right atrial signal. The remaining electrogram is thus identified as the SVC potential (arrowhead). C: Circular mapping catheter in the SVC. The first beat is a sinus beat followed by a PAC. The right atrium (arrow) is activated first in sinus rhythm, followed by the SVC potential (arrowhead). This relationship is reversed during PAC, with activation of the SVC potential occurring prior to activation of the right atrial signal. The phenomenon of “reversal of the near-field and far-field electrogram” proves that the “chamber of origin” of the PAC is the SVC. The origin of the PAC was mapped to the posterior SVC. D: SVC automaticity (arrows) during ablation at the SVC–right atrial venoatrial junction immediately following isolation of the SVC. Entrance block into the SVC is established at this point. HeartRhythm Case Reports 2016 2, 83-87DOI: (10.1016/j.hrcr.2015.11.004) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 A: Anatomic relationship of the superior vena cava (SVC), right superior pulmonary vein (RSPV), and the esophagus (arrow). B: Anatomic relationships of the SVC and aortocaval ganglion. The aortocaval ganglion is located in the aortocaval recess of the pericardium, which is bound anterolaterally by the SVC and posteromedially by the ascending aorta. The right pulmonary artery (RPA) forms the floor of the recess. The aortocaval ganglion receives parasympathetic preganglionic neurons from the vagus nerve. Postganglionic neurons then project to the sinus node, atrial muscle, and muscle sleeve of the SVC. LA = left atrium; RV = right ventricle. HeartRhythm Case Reports 2016 2, 83-87DOI: (10.1016/j.hrcr.2015.11.004) Copyright © 2016 Heart Rhythm Society Terms and Conditions