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Coronary sinus diverticulum with a concealed posteroseptal accessory pathway: a red herring?
A Gupta1, A M Vora, Y Lokhandwala
1Department of Cardiology, King Edward VII Memorial Hospital, Mumbai.
Indian Heart Journal
|July 18, 2001
Summary
Successful radiofrequency ablation treated paroxysmal tachycardia in a young male with a concealed posteroseptal accessory pathway. Ablation was effective endocardially under the mitral annulus, but not within the coronary sinus diverticulum.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Anatomy
Background:
- Accessory pathways can cause supraventricular tachycardia.
- Coronary sinus diverticula are rare congenital anomalies.
- Concealed accessory pathways pose diagnostic and therapeutic challenges.
Observation:
- A 21-year-old male presented with paroxysmal tachycardia.
- Electrophysiology study revealed a concealed posteroseptal accessory pathway.
- A diverticulum of the coronary sinus was identified concurrently.
Findings:
- Radiofrequency ablation successfully eliminated the accessory pathway conduction.
- Ablation was effective when performed endocardially beneath the mitral annulus.
- Radiofrequency ablation within the coronary sinus diverticulum was unsuccessful.
Implications:
- This case highlights successful ablation of a challenging accessory pathway.
- It underscores the importance of precise anatomical localization for ablation success.
- Management of accessory pathways in the presence of coronary sinus anomalies requires careful consideration.