Left-sided accessory pathway with ostial atresia of the coronary sinus: a case report

Area of Science:

• Cardiology
• Electrophysiology
• Congenital Heart Disease

Background:

• Atrioventricular (AV) reentrant tachycardia is a common supraventricular tachycardia.
• Coronary sinus (CS) anomalies, such as ostial atresia, are rare but can be associated with cardiac arrhythmias.
• Accurate diagnosis and targeted treatment are crucial for managing complex arrhythmias.

Observation:

• A patient presented with symptoms suggestive of AV reentrant tachycardia.
• Coronary venography revealed ostial atresia of the CS and dual anomalous venous drainage into both atria.
• No persistent left superior vena cava was identified.

Findings:

• Electrophysiological mapping identified a bypass tract associated with the anomalous venous drainage.
• Radiofrequency (RF) energy ablation was successfully applied to the mitral annulus, targeting the bypass tract.
• The procedure resulted in the elimination of the accessory pathway.

Implications:

• This case highlights the importance of considering rare coronary sinus anomalies in the etiology of AV reentrant tachycardia.
• Successful RF ablation in the presence of complex venous anatomy demonstrates the feasibility of curative treatment.
• Long-term symptom resolution suggests the efficacy of this approach for similar cases.