Key result
RF ablation at the coronary sinus diverticulum neck eliminates accessory pathway conduction in WPW.
Why the study?
Posteroseptal accessory pathways associated with coronary sinus diverticula present challenges for successful catheter ablation in WPW syndrome.
Case Report (n=1)
No
This case demonstrates that in patients with WPW syndrome and a posteroseptal accessory pathway, targeting the neck of a coronary sinus diverticulum can result in successful ablation when a transaortic approach fails.
Case suggests alternative access for posteroseptal pathways with CS diverticula; leaves open optimal ablation strategies.
Posteroseptal accessory pathways are often associated with coronary sinus diverticula. These diverticula contain myocardial coats which serve as a bypass tract. We report a 54-year-old woman who underwent radiofrequency (RF) catheter ablation for Wolff-Parkinson-White (WPW) syndrome. The surface electrocardiography (ECG) demonstrated pre-excitation, indicating a posteroseptal accessory pathway. A catheter ablation via a transaortic approach failed to ablate the accessory pathway. Coronary sinus venography revealed the presence of a diverticulum near the ostium. An electrogram in the neck of the diverticulum showed the coronary sinus myocardial extension potential, which was successfully ablated by delivery of RF energy.
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Jang et al. (2009) conducted a case report in Wolff-Parkinson-White syndrome (n=1). Radiofrequency catheter ablation was evaluated on Abolition of ventriculoatrial conduction via an accessory pathway. Radiofrequency catheter ablation in the neck of a coronary sinus diverticulum successfully eliminated accessory pathway conduction in a patient with Wolff-Parkinson-White syndrome.
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