Key result
Transesophageal echocardiography was as reliable as angiography for detecting coronary sinus diverticula (5/5) and middle cardiac veins (22/27), outperforming transthoracic echo (4/27; P<0.001).
Why the study?
Does echocardiography reliably identify coronary sinus diverticula and middle cardiac veins compared to angiography in patients with preexcitation syndrome?
Observational (n=33)
Does echocardiography reliably identify coronary sinus diverticula and middle cardiac veins compared to angiography in patients with preexcitation syndrome?
Echocardiography (particularly TEE) is as reliable as angiography for detecting and describing coronary sinus diverticula and middle cardiac veins in patients with preexcitation syndrome, potentially simplifying radiofrequency ablation.
Answers are grounded in this paper and cite their sources.
TEE may offer a noninvasive alternative to angiography for coronary sinus anatomy; leaves open prospective validation before changing ablation workflows.
To determine the value of echocardiography for identifying coronary sinus (CS) diverticula and middle cardiac veins (MCVs) in patients with posteroseptal accessory pathways (PAPs), transthoracic (TTE) and transesophageal echocardiography (TEE) were performed in 18 consecutive patients with PAP and in 15 control subjects with left lateral accessory pathway before CS angiography. The size, shape, and location of CS diverticula and MCV were described and compared to angiography. TEE and angiography were concordant for the identification of diverticula (n = 5) and agreed for depicting MCV in 22 of the 27 cases. TTE revealed 4 of 5 diverticula and identified 4 of 27 MCV (P < 0.001). Fourteen MCV but no diverticula were found in the control subject. There was no significant difference between transesophageal and angiographic measurements for the width (23.5 +/- 4.9 vs 26.8 +/- 6.6 mm) and height (13.5 +/- 3.8 vs 15.7 +/- 3.4 mm) of the diverticula, and the width (3.5 +/- 0.7 vs 3.7 +/- 0.6 mm) of MCV. TEE underestimated the length of the MCV (12.0 +/- 1.8 vs 27.2 +/- 6.0, P < 0.001). Delivery of radiofrequency energy within the neck of a diverticulum or within an MCV was successful in 5 of 5, and 6 of 13 cases in patients with PAPs, respectively. In conclusion, echocardiography was as reliable as angiography for detecting and describing CS diverticula and MCV in patients with preexcitation syndrome. Echocardiography is recommended prior to electrophysiological study because it may simplify radiofrequency catheter ablation.
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Omran et al. (1995) conducted an observational in Preexcitation syndrome (n=33). Transesophageal and transthoracic echocardiography vs. Coronary sinus angiography was evaluated on Identification of coronary sinus diverticula and middle cardiac veins (p=<0.001). Transesophageal echocardiography was as reliable as angiography for detecting coronary sinus diverticula (5/5) and middle cardiac veins (22/27), outperforming transthoracic echo (4/27; P<0.001).
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