Radiofrequency catheter ablation of accessory pathways associated with a coronary sinus diverticulum

Area of Science:

• Cardiology
• Electrophysiology
• Medical Imaging

Background:

• Accessory atrioventricular pathways can cause symptomatic arrhythmias.
• Posteroseptal pathways are sometimes challenging to ablate.
• Coronary sinus diverticula are rare anatomical variations.

Observation:

• Two patients presented with symptomatic posteroseptally located accessory atrioventricular pathways.
• Distinct electrocardiographic patterns were noted in the two patients.
• A coronary sinus diverticulum was identified as the origin of the pathway in both cases.

Findings:

• Radiofrequency catheter ablation within the diverticulum successfully interrupted the accessory pathway in both patients.
• This indicates that coronary sinus diverticula can be a substrate for accessory pathways.
• Successful ablation required precise localization within the diverticulum.

Implications:

• Coronary sinus angiography should be considered when ablation in the posteroseptal region is unsuccessful or lacks optimal signals.
• This diagnostic approach can improve the success rate of catheter ablation for challenging accessory pathways.
• Understanding this anatomical correlation enhances treatment strategies for supraventricular tachycardia.