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Bystander coronary sinus diverticulum and left anterolateral accessory pathway
A J Fuenmayor1, A M Fuenmayor, L Aranguibel
1Electrophysiology Section, Cardiovascular Research Center Abdel M Fuenmayor P, University of The Andes, Mérida, Venezuela. farocha@ing.ula.ve
Insights
This study reports a rare case of a concealed accessory pathway near the mitral annulus coexisting with a coronary sinus diverticulum. Successful radiofrequency ablation resolved the patient's supraventricular tachycardia.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Anatomy
Background:
- Accessory pathways can cause supraventricular tachycardia.
- Coronary sinus diverticula are rare congenital anomalies.
- Left posteroseptal pathways are sometimes found within coronary sinus diverticula.
Observation:
- A patient presented with recurrent paroxysmal supraventricular tachycardia.
- A concealed accessory pathway was identified at the left anterolateral mitral annulus.
- A left posterior coronary sinus diverticulum with an aneurysmal coronary sinus vein was also noted.
Findings:
- Electrophysiological study confirmed inducible orthodromic supraventricular tachycardia.
- Successful radiofrequency ablation of the accessory pathway was achieved.
- This case demonstrates the coexistence of a functional accessory pathway and a coronary sinus diverticulum.
Implications:
- Highlights the importance of thorough electrophysiological evaluation in patients with complex cardiac anatomy.
- Suggests accessory pathways may occur independently of coronary sinus diverticula.
- Provides insights into the anatomical substrate for supraventricular tachycardia.
Abstract:
Left posteroseptal accessory pathways have been described inside coronary sinus diverticula. We here describe the case of a patient who was suffering from recurrent episodes of paroxysmal supraventricular tachycardia and had a concealed accessory pathway located in the left anterolateral margin of the mitral annulus and a left posterior coronary sinus diverticulum associated with an aneurysmal coronary sinus vein. In the electrophysiological study, an orthodromic supraventricular tachycardia was induced and reproduced. We performed a successful radiofrequency ablation of the pathway. Our case provides evidence of the coexistence of concealed accessory pathways capable of sustaining orthodromic tachycardia coexisting with a bystander posterior coronary sinus diverticulum and aneurysmal coronary sinus vein.