Sinus node injury during adjunctive superior vena cava isolation in a patient with triggered atrial fibrillation

INTRODUCTION Atrial fibrillation is the most common sustained heart arrhythmia. Premature beats arising from foci other than pulmonary veins have been related to its pathogenesis. METHODS AND RESULTS A 64-year-old female underwent superior vena cava (SVC) isolation after triggers were identified originating from the SVC following pulmonary vein isolation; immediately after SVC isolation, she developed junctional rhythm with symptomatic hypotension requiring emergent management. Apical motion abnormalities were noticed in the echocardiography suggesting stress-induced cardiomyopathy which resolved 48 hours later. Although received a dual chamber pacemaker, intact sinus node function returned 2 weeks later. CONCLUSION Superior vena cava isolation in those with trigger mediated atrial fibrillation following pulmonary vein isolation (PVI) is performed to enhance long-term outcomes. Sinus node injury has been related previously to this procedure. We present the first case of time course of recovery of sinus node function, injured during SVC isolation.