Successful slow pathway ablation in a patient with a rare unroofed type coronary sinus

Area of Science:

• Cardiology
• Electrophysiology
• Anatomical Variations

Background:

• Atrioventricular nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia.
• Coronary sinus (CS) anomalies, such as persistent left superior vena cava, can complicate electrophysiological studies.
• Accurate anatomical assessment is crucial for successful catheter ablation in complex cases.

Observation:

• A patient presented with symptoms suggestive of AVNRT.
• Standard electrophysiological study attempts to cannulate the CS were unsuccessful.
• An angiogram revealed an unroofed coronary sinus anomaly, specifically a persistent left superior vena cava.

Findings:

• The coexistence of AVNRT and an unroofed CS anomaly presented a unique electrophysiological challenge.
• Anatomical guidance was essential for navigating the anomalous venous structure.
• Successful slow pathway ablation was achieved via a lesion in the right posterior paraseptum, utilizing an anatomical approach.

Implications:

• This case highlights the importance of recognizing and managing CS anomalies during electrophysiological procedures.
• Anatomical approaches can overcome challenges posed by congenital venous variations in tachycardia ablation.
• Successful ablation in such complex cases may improve patient outcomes and reduce recurrence rates.