Radiofrequency Catheter Ablation of Atrial Fibrillation in Patients with Anomalous Pulmonary Venous Return: A Multicenter Case Series.
- 1Mayo Clinic
Abstract
BackgroundAtrial fibrillation (AF) has been observed in adults with anomalous pulmonary venous return (APVR), but data on catheter ablation outcomes in this population remain limited to case reports and small series.
MethodsWe retrospectively reviewed 14 adult patients with confirmed APVR who underwent catheter ablation for AF at three tertiary academic centers in the United States between July 2003 and May 2025. Baseline, procedural, electroanatomic mapping, and outcome data were collected. Freedom from atrial arrhythmia recurrence was estimated by Kaplan-Meier analysis.
ResultsMean age was 56 {+/-} 13 years and 79% were male. Heart failure was present in 64%, and hypertension and coronary artery disease in 43% each. Most had partial APVR (86%), and 57% had prior surgical correction. Radiofrequency ablation was used in all patients, combined with pulsed-field ablation in one. Acute success was achieved in all patients, although areas with residual pulmonary vein or SVC electrical activity were left untreated in 3 (21%). Non-pulmonary-vein electrical activity was more common in patients with prior surgical correction than in those without (43% vs 17%). Median follow-up was 3.4 years (IQR, 2.0-9.6). Freedom from arrhythmia recurrence was 78.6% at 1 year and 53.9% at 5 years. Two patients (14%) required reablation; complications occurred in 3 (21%) without long-term sequelae.
ConclusionsCatheter ablation was acutely successful in all patients in this largest reported APVR cohort, despite substantial comorbidity burden and anatomic complexity. The arrhythmogenic substrate often extended beyond the anomalous vein, particularly in surgically corrected patients, supporting individualized, substrate-guided ablation in this population.
CLINICAL PERSPECTIVEO_ST_ABSWhat Is KnownC_ST_ABSO_LIAtrial fibrillation has been reported in adults with anomalous pulmonary venous return (APVR), but data on catheter ablation outcomes in this population are limited to case reports and small series. C_LI
What the Study AddsO_LIIn the largest reported cohort of patients with APVR undergoing catheter ablation for atrial fibrillation, pulmonary vein isolation achieved acute success in all patients despite substantial comorbidity burden and anatomic complexity. C_LIO_LINon-pulmonary-vein sites of electrical activity were more common among patients with prior surgical correction, and postsurgical scar and epicardial venoatrial connections were also arrhythmogenic, indicating that the arrhythmogenic substrate in APVR often extends beyond the anomalous vein itself. C_LIO_LIThese findings support individualized, substrate-guided mapping in patients with APVR, particularly those with a surgical history, and suggest a role for pulsed-field ablation near critical structures such as the phrenic nerve. C_LI
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BibTeX
@misc{estrada2026radiofrequency,
title = {{Radiofrequency Catheter Ablation of Atrial Fibrillation in Patients with Anomalous Pulmonary Venous Return: A Multicenter Case Series.}},
author = {C. Estrada and O. Baqal and M. Singh Sidhu and J. Y. Kim and V. de Sousa Barzon Serra and A. Kodikoppa Somappa and J. F. Rodriguez-Riascos and C. A. Rojas and K. Srivathsan},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.30.26363976},
url = {https://www.medrxiv.org/content/10.64898/2026.09.30.26363976v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Radiofrequency Catheter Ablation of Atrial Fibrillation in Patients with Anomalous Pulmonary Venous Return: A Multicenter Case Series.
AU - C. Estrada
AU - O. Baqal
AU - M. Singh Sidhu
AU - J. Y. Kim
AU - V. de Sousa Barzon Serra
AU - A. Kodikoppa Somappa
AU - J. F. Rodriguez-Riascos
AU - C. A. Rojas
AU - K. Srivathsan
PY - 2026
DA - 2026/09/30
PB - medRxiv
DO - 10.64898/2026.09.30.26363976
UR - https://www.medrxiv.org/content/10.64898/2026.09.30.26363976v1
AB - BackgroundAtrial fibrillation (AF) has been observed in adults with anomalous pulmonary venous return (APVR), but data on catheter ablation outcomes in this population remain limited to case reports and small series. MethodsWe retrospectively reviewed 14 adult patients with confirmed APVR who underwent catheter ablation for AF at three tertiary academic centers in the United States between July 2003 and May 2025. Baseline, procedural, electroanatomic mapping, and outcome data were collected. Freedom from atrial arrhythmia recurrence was estimated by Kaplan-Meier analysis. ResultsMean age was 56 {+/-} 13 years and 79% were male. Heart failure was present in 64%, and hypertension and coronary artery disease in 43% each. Most had partial APVR (86%), and 57% had prior surgical correction. Radiofrequency ablation was used in all patients, combined with pulsed-field ablation in one. Acute success was achieved in all patients, although areas with residual pulmonary vein or SVC electrical activity were left untreated in 3 (21%). Non-pulmonary-vein electrical activity was more common in patients with prior surgical correction than in those without (43% vs 17%). Median follow-up was 3.4 years (IQR, 2.0-9.6). Freedom from arrhythmia recurrence was 78.6% at 1 year and 53.9% at 5 years. Two patients (14%) required reablation; complications occurred in 3 (21%) without long-term sequelae. ConclusionsCatheter ablation was acutely successful in all patients in this largest reported APVR cohort, despite substantial comorbidity burden and anatomic complexity. The arrhythmogenic substrate often extended beyond the anomalous vein, particularly in surgically corrected patients, supporting individualized, substrate-guided ablation in this population. CLINICAL PERSPECTIVEO_ST_ABSWhat Is KnownC_ST_ABSO_LIAtrial fibrillation has been reported in adults with anomalous pulmonary venous return (APVR), but data on catheter ablation outcomes in this population are limited to case reports and small series. C_LI What the Study AddsO_LIIn the largest reported cohort of patients with APVR undergoing catheter ablation for atrial fibrillation, pulmonary vein isolation achieved acute success in all patients despite substantial comorbidity burden and anatomic complexity. C_LIO_LINon-pulmonary-vein sites of electrical activity were more common among patients with prior surgical correction, and postsurgical scar and epicardial venoatrial connections were also arrhythmogenic, indicating that the arrhythmogenic substrate in APVR often extends beyond the anomalous vein itself. C_LIO_LIThese findings support individualized, substrate-guided mapping in patients with APVR, particularly those with a surgical history, and suggest a role for pulsed-field ablation near critical structures such as the phrenic nerve. C_LI
ER -