Coronary sinus diverticulum as a cause of resistant posteroseptal pathway ablation
A Al Fagih1, G Al Zahrani, Y Al Hebaishi
1Department of Adult Cardiology, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia.
Insights
Coronary sinus diverticulum can cause persistent accessory pathway tachycardias. Ablating the diverticulum neck successfully treated a resistant case, offering a new strategy for complex arrhythmias.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Anatomy
Background:
- Coronary sinus (CS) anomalies are linked to accessory pathway-related tachycardias.
- CS diverticulum specifically affects 7-11% of patients with postero-septal or left posterior accessory pathways.
Purpose of the Study:
- To report a case of recurrent tachycardia due to a large CS diverticulum.
- To describe the successful radiofrequency ablation of a resistant accessory pathway within a CS diverticulum.
Main Methods:
- Electrophysiological study (EPS) and radiofrequency ablation.
- Coronary sinus angiography to identify the anomaly.
- Cardiac computerized tomography (CT) and trans-esophageal echocardiography to rule out other anomalies.
Main Results:
- A large CS diverticulum was identified as the cause of a resistant postero-septal accessory pathway.
- Successful radiofrequency ablation was performed at the neck of the CS diverticulum.
- No complications were observed post-ablation.
Conclusions:
- CS diverticulum can be a challenging anatomical factor in accessory pathway ablation.
- Targeting the diverticulum neck is a feasible and effective strategy for resistant accessory pathways.
- Comprehensive imaging is crucial for identifying associated anomalies.
Abstract:
Coronary sinus (CS) anomalies such as diverticulum, persistent left superior vena cava or CS ostium dilatation are predominantly found in patients with accessory pathway-related tachycardias. Diverticulum of the proximal CS found in 7-11% of patients with postero-septal or left posterior manifests accessory pathways. We reported a 28 year old gentleman with manifested postero-septal accessory pathway, who underwent repeat electrophysiological study (EPS) and radiofrequency ablation for previously failed ablation. Huge CS diverticulum was identified by angiography as a reason for resistant accessory pathway. Successful RF ablation was achieved at the neck of the diverticulum without complications. Other associated anomalies were ruled out by cardiac computerized tomography (CT) and trans-esophageal echocardiography.
