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Radiofrequency catheter ablation of a concealed atrioventricular accessory pathway associated with a coronary sinus
1Third Department of Internal Medicine, Nagasaki University School of Medicine, Japan. matsuok@net.nagasaki-u.ac.jp
Insights
Radiofrequency catheter ablation successfully treated a concealed accessory pathway linked to a coronary sinus diverticulum. Coronary sinus venography is crucial for identifying such anatomical variations before ablation procedures.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Accessory pathways can cause supraventricular tachycardia.
- Concealed accessory pathways, particularly in the posteroseptal region, pose ablation challenges.
- Coronary sinus diverticulum is a rare anomaly that can complicate accessory pathway ablation.
Observation:
- A 31-year-old woman presented with recurrent atrioventricular reciprocating tachycardia.
- Previous ablation attempts targeting the mitral annulus were unsuccessful.
- Coronary sinus venography identified a diverticulum near the coronary sinus ostium.
Findings:
- An electrogram within the diverticulum's neck demonstrated the shortest ventriculoatrial conduction time.
- A significant accessory pathway potential was recorded during tachycardia.
- Successful radiofrequency ablation was achieved at the neck of the coronary sinus diverticulum.
Implications:
- This case highlights the importance of pre-procedural coronary sinus venography for identifying anatomical variations like diverticula.
- Accurate anatomical identification can improve the success rate of catheter ablation for complex accessory pathways.
- Understanding the relationship between accessory pathways and coronary sinus diverticula is vital for effective treatment strategies.
Abstract:
A 31-year-old woman underwent radiofrequency catheter ablation of a concealed left posteroseptal accessory pathway associated with a coronary sinus diverticulum. The patient had previously undergone unsuccessful catheter ablation of the posteroseptal region of the mitral annulus. Coronary sinus venography revealed the presence of the diverticulum near the ostium. An electrogram in the neck of the diverticulum showed the shortest ventriculoatrial conduction time and a large accessory pathway potential during atrioventricular reciprocating tachycardia. The pathway was successfully ablated within the neck of the diverticulum. The findings in this case underscore the importance of coronary sinus venography before ablation.