Pulse Field Ablation for Persistent Atrial Fibrillation: Targeting the Persistent Superior Vena Cava
Bibliographic record
Abstract
Background: Persistent left superior vena cava (PLSVC) is a rare vascular anomaly that can act as a trigger for atrial fibrillation (AF) through its connections with the coronary sinus (CS) and the left atrium. While various ablation strategies have been proposed, thermal energy sources carry a high risk of complications. Pulse field ablation (PFA) offers a promising alternative due to its tissue selectivity and improved safety profile. Case Report: We report the case of a 68-year-old male with persistent AF and a history of prior catheter ablation, including pulmonary vein isolation (PVI) and conservative PLSVC ablation. After experiencing AF recurrence four years post-procedure, the patient underwent repeat ablation. Mapping revealed PV isolation but reconnection of the posterior wall and PLSVC. Ablation was performed using the Pulse Select PFA system (Medtronic), achieving successful posterior wall and PLSVC isolation. No complications occurred, and at six-month follow-up, the patient remained free of arrhythmia recurrence. Discussion: To our knowledge, this is the first reported case of PLSVC isolation using the Pulse Select catheter. Previous reports have described PFA with the FARAPULSE system (Boston), demonstrating its feasibility. The Pulse Select catheter employs a ”skipped bipolar” configuration, delivering energy between non-contiguous electrodes, which may result in slightly deeper lesions compared to conventional bipolar PFA catheters. Conclusion: PLSVC isolation using PFA is a feasible and safe approach that may help prevent AF recurrence. Further studies are needed to validate its long-term efficacy and safety.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".