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[Radiofrequency ablation of a posteroseptal accessory pathway associated with coronary sinus diverticulum]
J Villacastín1, J L Merino, J Almendral
1Departamento de Cardiología, Hospital Universitario Gregorio Marañón, Madrid.
Abstract:
The case of a patient with a symptomatic Wolff-Parkinson-White syndrome undergoing attempted radiofrequency catheter ablation of a posteroseptal accessory pathway is described. Coronary sinus venography revealed the presence of a diverticulum attaching near the os. The electrogram recorded from a catheter placed in the narrow neck of the diverticulum revealed a short atrioventricular time during sinus rhythm. The pathway was easily ablated using radiofrequency energy applied in the neck of the diverticulum, after multiple failed attempts at catheter ablation from the endocardial surface of the posteroseptal space. Our report emphasizes the importance of searching for a coronary venous diverticulum in all patients with posterior accessory pathways undergoing catheter ablation.
Insights
Radiofrequency ablation of posteroseptal accessory pathways in Wolff-Parkinson-White syndrome can be challenging. Identifying a coronary sinus diverticulum is crucial for successful ablation, as targeting this anatomical variation improves outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Symptomatic Wolff-Parkinson-White syndrome requires effective treatment.
- Radiofrequency catheter ablation is a common treatment for accessory pathways.
Observation:
- A patient with a posteroseptal accessory pathway presented challenges during ablation.
- Coronary sinus venography identified a diverticulum near the coronary sinus os.
- Electrograms from the diverticulum's neck showed a short atrioventricular time.
Findings:
- Radiofrequency ablation was successful when applied to the diverticulum's neck.
- Previous attempts targeting the endocardial surface failed.
Implications:
- Coronary sinus diverticula should be investigated in patients with posterior accessory pathways.
- Identifying and targeting diverticula can improve ablation success rates.
- This approach may enhance safety and efficacy in complex ablation cases.