Why the study?
PLSVC is accompanied by an enlarged CS and deformation of the triangle of Koch, making anatomical evaluation of the AV nodal pathways difficult.
Retrograde fast pathway cryoablation inside the coronary sinus roof is a feasible treatment for slow-fast AVNRT in patients with persistent left superior vena cava.
Supports CS roof cryoablation for AVNRT in PLSVC; leaves open confirmation in larger series.
INTRODUCTION: Persistent left superior vena cava (PLSVC) is accompanied by enlarged coronary sinus (CS) and deformation of the triangle of Koch. This makes anatomical evaluation of the atrioventricular (AV) nodal pathways difficult. METHODS: We attempted cryoablation of retrograde fast pathway located in the enlarged CS roof of PLSVC for slow-fast AV nodal reentrant tachycardia (AVNRT) induced by inadvertent antegrade fast pathway elimination during ablation of left atrial tachycardia. RESULTS: Slow-fast AVNRT was successfully eliminated without AV block progression. CONCLUSIONS: This is the first case of successful retrograde fast pathway ablation of the CS ostial roof for slow-fast AVNRT with PLSVC.
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Arai et al. (2022) studied this question.
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