Single-shot cryoablation of an epicardial inferoparaseptal accessory pathway: a case report

Figures

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  Figure 1. Electrocardiogram with a delta wave. The negative delta wave in inferior leads indicates the inferoparaseptal localization of the accessory pathway.

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  Figure 2. Coronary sinus anatomy visualization and middle cardiac vein cannulation. (A) Early branching of the coronary sinus with middle and posterior cardiac veins stenosis, (B) coronary sinus main trunk cannulation with a 0.035-inch wire (arrow) to support delivery system at ostium (star) and middle cardiac vein cannulation (curved arrow), (C) middle cardiac vein balloon dilatation (curved arrow), and (D) catheter Max Freezor inside middle cardiac vein (star).

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  Figure 3. Posterior cardiac vein (A–C) stepwise dilatation (curved arrow), 0.035-inch wire is in the coronary sinus main trunk, (C) cryocatheter in the posterior cardiac vein (star).

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  Figure 4. Zoomed electrocardiogram tracings and intracardiac electrograms from the mapping catheter (A) in the posterior cardiac vein, (B and C) inferoparaseptal region. (A) The maximal preexcitation results in the absence of discreet A and V signal on the mapping catheter at the successful ablation site in the posterior cardiac vein. (B) A local pre-excitation on the mapping catheter placed 1 cm into the coronary sinus with atrial-to-ventricular electrogram amplitude ratio of 1:2, (C) a local pre-excitation on the mapping catheter at the left endocardial inferoparaseptal region with A:V ratio of 1:3.

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  Figure 5. Effective cryocatheter ablation of accessory pathway. Electrocardiogram and intracardiac electrograms from the ablation catheter (Freezor 1,2—blue star), right atrium, and right ventricle. The first four QRS complexes presented with delta waves. Within 10 s, conduction over the accessory pathway was interrupted (the three narrow QRS complexes after arrow).

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