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March 31, 2026HeartRhythm Case ReportsOpen Access

The patient developed recurrent symptomatic atrial tachycardia 10 days after the initial pulsed field ablation procedure, which was mapped as superior vena cava upper loop macroreentry and successfully terminated with radiofrequency ablation.

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Population

1 adult with heart failure owing to persistent atrial fibrillation, with initially reduced LVEF that…

Design

Case_report

Follow-up

3 months

Discussion

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Overview

May signal unintended SVC reentry after distal RSPV PFA; leaves open its incidence and prevention.

Structured PICO

P
Population
1 adult (57-year-old man) with heart failure owing to persistent atrial fibrillation, with initially reduced LVEF (30%) that improved to 60% after cardioversion.
I
Intervention
Pulmonary vein isolation using a pentaspline pulsed field ablation catheter (FARAPULSE) with 61 applications, including an olive-shaped configuration at the right superior pulmonary vein, plus empirical cavotricuspid isthmus radiofrequency ablation.
O
Outcome
Development of superior vena cava reentrant atrial tachycardia.

Pulsed field ablation at the distal right superior pulmonary vein may unintentionally affect the superior vena cava, potentially creating a substrate for reentrant atrial tachycardia.

Limitations

  • Preexisting low-voltage substrate cannot be completely excluded because right atrium and superior vena cava voltage mapping was not performed before pulsed field ablation at the initial procedure.
  • Considerations regarding the mechanism remain speculative and require future studies.

Cite This Study

A 2026 study studied this question.

synapsesocial.com/papers/6a025cd7edf6f48138594a51https://doi.org/10.1016/j.hrcr.2026.03.016
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