Remaining challenges in catheter ablation of accessory pathways: rare entity of coronary sinus...

Area of Science:

• Cardiology
• Electrophysiology
• Interventional Cardiology

Background:

• Coronary sinus (CS) diverticula are rare complications during catheter ablation procedures.
• Limited case reports exist on CS diverticula complicating accessory pathway (AP) ablation.

Purpose of the Study:

• To investigate the incidence and management of CS diverticula in patients undergoing AP ablation.
• To evaluate the success rates and long-term outcomes of ablation in the presence of CS diverticula.

Main Methods:

• Retrospective analysis of 2245 patients undergoing AP ablation from 1993 to 2016.
• Identification of 8 patients (0.36%) with CS diverticula via venography.
• Detailed analysis of pathway characteristics, ablation techniques, and patient outcomes.

Main Results:

• Eight patients (0.36%) with CS diverticula were identified.
• Conventional ablation failed in 7 of 8 cases; success was achieved using specialized catheters (8-mm tip, irrigated tip, cryoablation) or alternative venous access.
• One patient had an unsuccessful ablation, while the remaining seven achieved successful ablation with no recurrences during a mean follow-up of 8.9 years.

Conclusions:

• Venography of the coronary sinus is recommended for inferoseptal pathways, particularly after failed ablation attempts.
• Successful ablation of accessory pathways in the presence of CS diverticula results in an excellent long-term prognosis.