Accessory pathway in left inferoposterior diverticulum masquerading as left posterior pathway due to conduction over...

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Anatomy

Background:

• Accessory pathways can cause supraventricular tachycardia.
• Left lateral pathways are common targets for ablation.
• Diverticula can present diagnostic challenges in electrophysiology.

Observation:

• A patient presented with recurrent supraventricular tachycardia despite multiple failed ablation procedures.
• The accessory pathway was located in a left inferoposterior diverticulum.
• Activation patterns suggested a left lateral pathway, complicating diagnosis.

Findings:

• The accessory pathway's activation sequence mimicked a left lateral pathway due to a coronary sinus to left atrium connection.
• The true anatomical substrate was an inferoposterior diverticulum, not a typical left lateral location.
• This case highlights a rare cause of ablation failure.

Implications:

• Accurate anatomical localization is crucial for successful ablation of accessory pathways.
• Unusual pathway locations and activation patterns require careful electrophysiological assessment.
• Understanding rare cardiac anomalies can improve treatment strategies for complex arrhythmias.