Pacing maneuvers for nonpulmonary vein sources: Part II

  • Samuel J. Asirvatham
    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.
    Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
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Published:January 15, 2007DOI:
      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.
      • Asirvatham S.J.
      Anatomy of the vena cava: an electrophysiological perspective.
      The following are commonly encountered situations and maneuvers specific to SVC isolation.
      Figure thumbnail gr1
      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).


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        • Asirvatham S.J.
        Anatomy of the vena cava: an electrophysiological perspective.
        in: Chen S.A. Haissaguerre M. Zipes D.P. Thoracic Vein Arrhythmias: Mechanisms and Treatment. Blackwell Futura, Malden, MA2004: 54-65
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        Identifying far-field superior vena cava potentials within the right superior pulmonary vein.
        Heart Rhythm. 2006; 3: 898-902