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Published on: February 26, 2013
Radiofrequency ablation of posteroseptal accessory pathways associated with coronary sinus diverticula
Raja J Selvaraj1, Krishna Sarin2, Vivek Raj Singh2
1Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India. rajajs@gmail.com.
Insights
Coronary sinus diverticula are linked to posteroseptal accessory pathways. Suspect diverticula in patients with prior ablation failure, atrial fibrillation, or specific ECG findings for successful treatment.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Posteroseptal accessory pathways can be associated with coronary sinus (CS) diverticula.
- Understanding this association is crucial for effective ablation strategies.
Purpose of the Study:
- To characterize the clinical presentation, electrophysiological mapping, and ablation outcomes of posteroseptal accessory pathways in patients with and without CS diverticula.
Main Methods:
- Retrospective analysis of patients undergoing posteroseptal accessory pathway ablation.
- Comparison of clinical data, mapping findings, and ablation success between patients with (Group I) and without (Group II) CS diverticula.
Main Results:
- 16 patients had CS diverticula (Group I), 35 did not (Group II).
- Atrial fibrillation and prior ablation failure were more frequent in Group I.
- A negative delta wave in lead II best identified diverticula; shorter ventricular electrogram to delta wave onset interval noted in Group I.
Conclusions:
- CS diverticula should be suspected in patients with posteroseptal pathways, especially with prior ablation failure, AF, or specific ECG patterns.
- While pathway potentials are common, local ventricular electrograms may be less early compared to other pathways.
Purpose:
Posteroseptal accessory pathways may be associated with a coronary sinus (CS) diverticulum. Our purpose was to describe the clinical characteristics, mapping and ablation of these pathways.
Methods:
This was a retrospective study of all patients who underwent ablation of posteroseptal accessory pathways in a single centre. Patients with a diverticulum of the CS or one of its tributaries were included in group I, while the other patients formed group II. Clinical presentation, ablation procedure and outcome were compared between the two groups.
Results:
A total of 51 patients were included, 16 in group I and 35 in group II. There were no significant differences in age or sex distribution. Atrial fibrillation (AF) and previous unsuccessful ablation were more common in group I. A negative delta wave in lead II was the ECG finding with best sensitivity and specificity for the presence of a diverticulum. A pathway potential was common at the successful site in group I, and the interval between local ventricular electrogram and delta wave onset was shorter (19.5 ± 8 vs 33.1 ± 7.6 ms, p < 0.001). There was a trend toward lower procedural success rate and higher recurrence rate in group I, although this was not significant.
Conclusions:
CS diverticula should be suspected in patients with manifest posteroseptal accessory pathways who have a previous failed ablation, documented AF or typical electrocardiographic signs. A discrete potential is frequently seen at the successful site, but the local ventricular electrogram is not as early as in other accessory pathways.
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