Why the study?
Wolff-Parkinson-White syndrome is treated by ablating the accessory pathway, but pathways located in the posteroseptal region can be challenging.
In cases of WPW with a coronary sinus diverticulum where standard ablation fails, the middle cardiac vein should be considered as a potential site for an epicardial posteroseptal accessory pathway.
May support middle cardiac vein targeting in select refractory cases; leaves open generalizability and requires prospective validation.
Wolff-Parkinson-White syndrome is a congenital cardiac pre-excitation syndrome that is effectively treated by ablating the accessory pathway. However, accessory pathways located in the posteroseptal region can sometimes be challenging. In this paper, we present the successful ablation of the epicardial posteroseptal accessory pathway through the middle cardiac vein in a 13-year-old girl with a coronary sinus diverticulum and Wolff-Parkinson-White syndrome, after unsuccessful ablation attempts at different locations. If the ablation procedure fails, the possibility of the posteroseptal pathway should be kept in mind, and coronary sinus angiography should be performed. In cases with a coronary sinus diverticulum where ablation is not successful, other coronary sinus structures, for example, the middle cardiac vein should be considered as potential accessory pathways.
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Torun et al. (2023) studied this question.
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