The case of a patient with Wolff-Parkinson-White syndrome undergoing attempted radiofrequency catheter ablation of a left posterior paraseptal accessory pathway is described. Coronary sinus venography revealed the presence of a large diverticulum attaching near the os. The electrogram recorded from a catheter placed in the narrow neck of the diverticulum revealed a very short atrioventricular time during sinus rhythm. The pathway was easily ablated using radiofrequency energy applied in the neck of the diverticulum, after multiple failed attempts at catheter ablation from the endocardial surface of the mitral annulus. Our report emphasizes the importance of searching for a coronary sinus diverticulum in all patients with posterior accessory pathways undergoing catheter ablation.
Ablation of the slow pathway to cure AV nodal reentrant tachycardia does not produce any gross or histologic damage to the AV node, suggesting that the AV nodal reentrant circuit does not exist in its entirety in the AV node.
These findings demonstrate that under strict hemodynamic control the presence of steal-prone anatomy does not confer an increased risk in the development of intraoperative myocardial ischemia.
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