Electroanatomical mapping and radiofrequency ablation of an accessory pathway associated with a large aneurysm of the
Monther Boulos1, Lior Gepstein
1Cardiology Department, Rambam Medical Center, Haifa, Israel.
Insights
This study details a successful ablation of a complex accessory pathway linked to a coronary sinus aneurysm after prior failed attempts. Advanced electroanatomical mapping precisely guided the procedure, ensuring a safe and effective outcome.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Accessory pathways can be challenging to ablate, especially when associated with complex cardiac anatomy.
- Coronary sinus aneurysms are rare and can complicate ablation procedures for adjacent arrhythmias.
Observation:
- A patient presented with a left posteroseptal accessory pathway and a concomitant coronary sinus aneurysm.
- Two prior ablation attempts at other centers were unsuccessful despite extensive radiofrequency energy delivery.
Findings:
- Three-dimensional electroanatomical mapping precisely visualized the coronary sinus aneurysm and the accessory pathway's ventricular insertion site.
- Successful ablation of the accessory pathway was achieved without complications using the detailed anatomical information.
Implications:
- Electroanatomical mapping is crucial for complex ablation cases involving structural anomalies like coronary sinus aneurysms.
- This case highlights a potential strategy for managing challenging accessory pathway ablations in the presence of coronary sinus aneurysms.
Abstract:
We report a case of a patient with a left posteroseptal accessory pathway associated with a coronary sinus (CS) aneurysm. The patient had undergone two previous failed ablation attempts at other institutions despite multiple radiofrequency applications delivered within and outside the CS aneurysm. Electroanatomical mapping was performed and allowed delineation of the three-dimensional anatomy of the aneurysm, so as to identify the ventricular insertion site, and to permit successful ablation of the pathway without any complications.
