Irrigated radiofrequency ablation within a middle cardiac vein diverticulum successfully eliminated accessory pathway conduction in a pregnant woman with WPW syndrome and cardiac arrest.
Case Report (n=1)
Fractionated delta waves in Wolff-Parkinson-White syndrome may indicate an epicardial accessory pathway associated with a middle cardiac vein diverticulum, which can be successfully treated with targeted ablation.
A 26-year-old woman at 34 weeks’ gestation presented with out-of-hospital cardiac arrest due to ventricular fibrillation. Her electrocardiogram (ECG) showed sinus rhythm with a short P–R interval and an unusually fractionated delta wave. The delta wave was positive in leads I and V2–V6, isoelectric in V1, and negative in inferior leads. An electrophysiology study revealed antegrade accessory pathway conduction with the earliest ventricular activation in the posteroseptal region. Three radiofrequency (RF) ablation procedures, including attempts with pulsed field ablation, were ultimately unsuccessful. Cardiac computed tomography angiography revealed a diverticulum of the middle cardiac vein (MCV). Irrigated RF ablation within the diverticulum successfully eliminated the accessory pathway conduction. We propose that multiple fibers of the coronary sinus or the MCV muscular coat may interface via the diverticulum with the ventricle, leading to multiple wavefronts of ventricular pre-excitation, and that the resultant delta-wave fractionation may allow identification of such an epicardial accessory pathway.
Sileshi et al. (Fri,) conducted a case report in Wolff-Parkinson-White Syndrome with out-of-hospital cardiac arrest (n=1). Irrigated radiofrequency ablation within the middle cardiac vein diverticulum was evaluated on Elimination of accessory pathway conduction. Irrigated radiofrequency ablation within a middle cardiac vein diverticulum successfully eliminated accessory pathway conduction in a pregnant woman with WPW syndrome and cardiac arrest.