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Address reprint requests and correspondence: Dr. Samuel J. Asirvatham, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905.
Superior vena caval (SVC) potentials are similar to pulmonary vein (PV) potentials.
The concepts of multiple far-field electrograms and the use of perivenous pacing and
specific site and simultaneous pacing described above are equally applicable to understanding
the complex electrograms found within the SVC (Figure 1). Specific sites that require pacing to determine the components of a complex electrogram
found in the SVC include the right atrium (RA), azygos vein, anomalous PVs draining
into the SVC, and right upper PV; in some cases, an anomalous superior branch of the
right inferior PV may be required.
The following are commonly encountered situations and maneuvers specific to SVC isolation.
Figure 1If a non–left atrium to pulmonary vein (PV) connection (e.g., right atrium to right
upper PV) is suspected, “paravenous” pacing can be performed, shown here from two
sites, each with higher-output and low-output pacing. If a true connection is found,
the site of earliest activation in the PV is independent of pacing output and the
site in the right atrium where pacing is performed (see text for details).
