Pulsed Field Ablation of Persistent Left Superior Vena Cava in an Athlete With Atrial Fibrillation.

BACKGROUND

Masters endurance athletes have an elevated risk of atrial fibrillation (AF) due to atrial remodeling, autonomic shifts, and long-term training loads. Management is challenging when persistent AF limits performance despite guideline-directed care.

CASE SUMMARY: A 60-year-old lifelong swimmer and cyclist with persistent AF experienced a 20% to 25% decline in exercise performance. AF recurred shortly after pulmonary vein isolation, and antiarrhythmic drugs were ineffective or poorly tolerated. A known persistent left superior vena cava (PLSVC) suggested a non-pulmonary vein trigger. Repeat ablation with pulsed field ablation successfully isolated the PLSVC without complications. Follow-up demonstrated restored exercise capacity and no sustained AF recurrence.

DISCUSSION: This case highlights the role of non-pulmonary vein triggers in athletes and the potential safety advantages of pulsed field ablation for complex anatomical targets.

TAKE-HOME MESSAGE: Pulsed field ablation may safely isolate arrhythmogenic PLSVC and restore performance in endurance athletes.