Atrial Tachycardia in the Coronary Sinus Communicating With Circumflex Artery Aneurysm

Area of Science:

• Cardiology
• Electrophysiology
• Congenital Heart Disease

Background:

• Coronary artery fistula (CAF) is a rare congenital anomaly where coronary arteries connect abnormally to heart chambers or other vessels.
• Atrial tachycardia (AT) originating from the coronary sinus (CS) is an uncommon arrhythmia, particularly in the context of CAFs.
• Left circumflex artery aneurysms associated with CS fistulas are exceptionally rare.

Purpose of the Study:

• To report a rare case of localized re-entrant atrial tachycardia (AT) originating from the coronary sinus (CS) in a patient with a coexisting left circumflex artery aneurysm and CS fistula.
• To describe the successful management of this complex case using radiofrequency catheter ablation.

Main Methods:

• Case report detailing a patient with a left circumflex artery aneurysm and coronary sinus fistula.
• Utilized electrophysiological study to identify the origin of the atrial tachycardia.
• Performed radiofrequency catheter ablation targeting the arrhythmogenic substrate within the coronary sinus.

Main Results:

• A localized re-entrant atrial tachycardia was identified originating from the coronary sinus.
• Radiofrequency catheter ablation successfully terminated the arrhythmia.
• The patient remained free from tachycardia post-ablation.

Conclusions:

• This case highlights the rare association between coronary artery fistulas, specifically left circumflex artery aneurysms, and coronary sinus-originating atrial tachycardia.
• Radiofrequency catheter ablation is an effective treatment for localized re-entrant AT in the coronary sinus, even in the presence of complex coronary anomalies.