Pulsed field catheter ablation of persistent left superior vena cava: acute safety and feasibility with a circular array PFA system
V A Sagar, J S Gill, A Bajpai, Z Akhtar, L W M Leung, M M GallagherAbstract
Background
Persistent left superior vena cava (PLSVC) is a common thoracic venous anomaly that can serve as a significant source of arrhythmogenic activity in patients with atrial fibrillation (AF). Conventional thermal ablation of PLSVC is technically challenging due to complex venous anatomy and proximity to critical cardiac structures, leading to suboptimal outcomes and procedure risk. Pulsed field ablation (PFA), a non-thermal energy modality with relative myocardial selectivity, may overcome these limitations.
Purpose
The study aimed to evaluate the feasibility, safety, and acute efficacy of PLSVC isolation using the circular array PFA catheter, in patients undergoing AF ablation.
Methods
Between October 2024 and September 2025, Pulsed field catheter ablation of AF was performed in 630 patients at our institute. Of these, 151 procedures were carried out using the Circular array PFA catheter. Among these six patients (0.95%) had a PLSVC. These patients underwent target PLSVC isolation in addition to standard ablation strategies. Procedural characteristics and outcomes were compared with those of patients with typical venous anatomy. All procedures were performed under general anaesthesia with/without electroanatomic mapping system.
Results
PLSVC isolation was achieved in all six patients (100%) without periprocedural complications using circular array catheter. The median number of PFA applications was 72 (IQR 50 – 85), and the mean procedural duration was 120 ± 64 minutes. No acute complications occurred. During follow-up, one patient demonstrated arrhythmia recurrence at six months, while four maintained stable sinus rhythm, and two patients were asymptomatic during the blanking period.
Conclusions
Electrical isolation of the PLSVC using the circular array PFA catheter is feasible, safe, and acutely effective in patients with atrial fibrillation. The catheter design facilitates efficient isolation while minimising risk to adjacent structures, highlighting PFA as a promising alternative to conventional thermal ablation. Longer-term studies are warranted to confirm durability and clinical benefit.Pre-Post ablation map of PLSVC