Early septal activation, successful lateral ablation
Hamid Reza Bonakdar1, Amir Farjam Fazelifar, Zahra Emkanjoo
1Department of Pacemaker and Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Centre, Tehran, Iran.
Insights
Changes in coronary sinus activation patterns during ablation can indicate accessory pathways. Intra-atrial conduction block can reverse these patterns, potentially leading to complications if overlooked.
Area of Science:
- Electrophysiology
- Cardiology
- Cardiac Electrophysiology
Background:
- The coronary sinus activation pattern is crucial for identifying arrhythmia mechanisms and accessory pathways.
- Understanding these patterns aids in radiofrequency ablation strategies.
- Changes during ablation require careful evaluation for additional pathways or pathway innocence.
Observation:
- Intra-atrial conduction block can significantly alter the coronary sinus activation pattern.
- This phenomenon can be misinterpreted if not recognized.
- A case involving left lateral accessory pathway conduction demonstrated a complete reversal of the pattern due to intra-atrial block.
Findings:
- Intra-atrial conduction block can mimic or mask accessory pathway signals.
- The coronary sinus activation pattern is not static and can be influenced by conduction abnormalities.
- Complete reversal of the expected pattern was observed in the presented case.
Implications:
- Failure to recognize intra-atrial conduction block can lead to misdiagnosis and inappropriate ablation strategies.
- Awareness of this phenomenon is vital to prevent irreversible complications during electrophysiological procedures.
- This case highlights the importance of considering conduction system changes during cardiac ablation.
Abstract:
The coronary sinus activation pattern is an important clue for the detection of arrhythmia mechanisms and/or localization of accessory pathways. Any change in this pattern during radiofrequency ablation should be evaluated carefully to recognize the presence of another accessory pathway or innocence of the accessory pathway during arrhythmia. Intra-atrial conduction block can change the coronary sinus activation pattern. Negligence regarding this phenomenon can cause irreversible complications. Here we describe a case with left lateral accessory pathway conduction in which intra-atrial conduction block completely reversed the coronary sinus activation pattern.
