Posteroseptal accessory pathway in association with coronary sinus diverticulum: electrocardiographic description and result of catheter ablation

Payami, Babak; Shafiee, Akbar; Shahrzad, Maryam; Kazemisaeed, Ali; Davoodi, Gholamreza; Yaminisharif, Ahmad

doi:10.1007/s10840-012-9775-1

Cited by 21 publications

(34 citation statements)

References 18 publications

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“…Approximately 19%–33% of accessory pathways can lie near or within the coronary sinus (CS) ostium, proximal CS, or CS diverticulum, 1–3 often referred to as inferior paraseptal (and previously posteroseptal) accessory pathways. 4 Although accessory pathway–mediated AV reentrant tachycardia can be managed pharmacologically, radiofrequency catheter ablation has become a well-established treatment option for these patients.…”

Section: Introductionmentioning

confidence: 99%

Catheter ablation of accessory pathways near the coronary sinus: Value of defining coronary arterial anatomy

et al. 2015

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BACKGROUND Accessory pathways can lie near or within the coronary sinus (CS). Radiofrequency catheter ablation of accessory pathways is a well-established treatment option, but this procedure can cause damage to adjacent coronary arteries. OBJECTIVE The purpose of this study was to evaluate the anatomic relationship between the coronary arteries and the CS. METHODS Retrospective data of patients who underwent catheter ablation of supraventricular tachycardia between June 2011 and August 2013 was reviewed. In addition, detailed analysis of coronary computed tomographic angiography (CTA) data from 50 patients was performed. RESULTS Between June 2011 and August 2013, 427 patients underwent catheter ablation of supraventricular tachycardia, of whom 105 (age 28 ± 17 years, 60% male) had accessory pathway–mediated tachycardia. Of these, 23 patients had accessory pathways near the CS, and 60% (N = 14) underwent concurrent coronary angiography. In 4 patients, the posterolateral (inferolateral) branch (PLA) of the right coronary artery was in close proximity to the CS, and 2 patients (18%) had stenosis of the PLA at the site of ablation. On CTA at their closest proximity, the PLA was 1.9 ± 1.3 mm and the left circumflex artery (LCx) was 2.0 ± 0.8 mm from the body of the CS, in right and left coronary artery–dominant patients, respectively. CS ostium and PLA were 3.6 ± 1.9 mm apart. In left-dominant patients, LCx and CS ostium were 3.8 ± 1.2 mm apart. CONCLUSION The PLA and LCx are in close proximity to the anteroinferior aspect of the CS ostium and proximal CS. The relationship of the CS and coronary arteries should be evaluated before ablation at these sites.

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Section: Introductionmentioning

confidence: 99%

Catheter ablation of accessory pathways near the coronary sinus: Value of defining coronary arterial anatomy

et al. 2015

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“…In the procedure in this case, the electrode impedance was unstable during the initial ablation and a change of the ablation catheter was required, which might have resulted in the tip coming in contact with the aneurysm. The previous reports described that there was a lower success rate and higher complication rate of catheter ablation of accessory pathways related to CS aneurysms . Our case would indicate that a CS angiogram might be recommended in cases in which the catheter tip impedance or temperature is too unstable during radiofrequency delivery during PJRT ablation.…”

Section: Discussionmentioning

confidence: 56%

“…The previous reports described that there was a lower success rate and higher complication rate of catheter ablation of accessory pathways related to CS aneurysms. 8,9 Our case would indicate that a CS angiogram might be recommended in cases in which the catheter tip impedance or temperature is too unstable during radiofrequency delivery during PJRT ablation. If CS anomaly was found, contact force monitoring would be useful for a successful ablation and to avoid complications.…”

Section: Discussionmentioning

confidence: 90%

Coexistence of a permanent form of a junctional reciprocating tachycardia and coronary sinus aneurysm: A case report

Shimizu

Inaba

Goya

et al. 2017

Pacing Clinical Electrophis

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A 58-year-old man with a long R-P' narrow QRS tachycardia underwent an electrophysiological study. The tachycardia was diagnosed as a permanent form of junctional reciprocating tachycardia (PJRT), and the earliest atrial activation site during tachycardia was coronary sinus (CS) ostium. Radiofrequency ablation at the site was initially not successful because the tip impedance and temperature were unstable. After changing of the ablation catheter to that with contact force sensor, the accessory pathway was immediately ablated and the PJRT was no longer induced. A retrograde CS angiogram revealed a fusiform aneurysm, which was located at the earliest activation site during the tachycardia.

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“…Second, this study did not include patients with an epicardial accessory pathway. Previous studies reported that a posteroseptal accessory pathway traversed the subepicardial region in some patients. In these cases, negative deflection of the retrograde P wave in the inferior leads may become large.…”

Section: Discussionmentioning

confidence: 95%

Differentiation of Slow‐Slow Form of AVNRT from AVRT through a Posteroseptal Accessory Pathway by Retrograde P‐Wave Amplitude

Nakatani

Mizumaki

Sakamoto

et al. 2016

Pacing Clinical Electrophis

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Posteroseptal accessory pathway in association with coronary sinus diverticulum: electrocardiographic description and result of catheter ablation

Abstract: Our total initial failure rate and subsequent recurrence was around 41 %. Better results might have been achieved had we applied irrigated tip catheters or NavX(TM)-guided cryoablation or subxiphoid epicardial mapping and ablation.

Cited by 21 publications

References 18 publications

Catheter ablation of accessory pathways near the coronary sinus: Value of defining coronary arterial anatomy

Catheter ablation of accessory pathways near the coronary sinus: Value of defining coronary arterial anatomy

Coexistence of a permanent form of a junctional reciprocating tachycardia and coronary sinus aneurysm: A case report

Differentiation of Slow‐Slow Form of AVNRT from AVRT through a Posteroseptal Accessory Pathway by Retrograde P‐Wave Amplitude

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