Atrial fibrillation ablation with persistent left superior vena cava detected during intracardiac echocardiography  Victor A. Abrich, MD, Jeffrey Munro,

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Atrial fibrillation ablation with persistent left superior vena cava detected during intracardiac echocardiography  Victor A. Abrich, MD, Jeffrey Munro, DO, Komandoor Srivathsan, MD  HeartRhythm Case Reports  Volume 3, Issue 10, Pages 455-458 (October 2017) DOI: 10.1016/j.hrcr.2017.06.004 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Fluoroscopic images. A: Ablation catheter placed at the focus of earliest activation, distal to the distal poles of the duodecapolar coronary sinus catheter. B: Coronary sinus venogram with the duodecapolar catheter placed in a dilated coronary sinus. C: Left upper extremity peripheral venogram showing contrast runoff into a persistent left superior vena cava. HeartRhythm Case Reports 2017 3, 455-458DOI: (10.1016/j.hrcr.2017.06.004) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 Intracardiac electrogram at the onset of atrial fibrillation. After the last beat of sinus rhythm, the earliest potential was noted on the distal pole of the ablation catheter located in the distal coronary sinus, before the earliest CS 1,2 electrogram. This is followed by atrial tachycardia degenerating into atrial fibrillation. ABL = ablation; CS = coronary sinus; d = distal; p = proximal; RA = right atrium. HeartRhythm Case Reports 2017 3, 455-458DOI: (10.1016/j.hrcr.2017.06.004) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 Intracardiac echocardiographic views. A: Dilated CS coming off the RA. B: Duodecapolar catheter inside a dilated CS. C: View of the CS during transseptal puncture. CS = coronary sinus; LA = left atrium; RA = right atrium. HeartRhythm Case Reports 2017 3, 455-458DOI: (10.1016/j.hrcr.2017.06.004) Copyright © 2017 Heart Rhythm Society Terms and Conditions