A posteroseptal accessory pathway located in a coronary sinus aneurysm: diagnosis and radiofrequency catheter ablation

A coronary sinus aneurysm was diagnosed by means of echocardiography, coronary sinus contrast angiography, coronary angiography, and nuclear magnetic resonance imaging in a patient with Wolff-Parkinson-White syndrome caused by a posteroseptal accessory pathway. Percutaneous radiofrequency current catheter ablation performed in the isthmus of the coronary sinus aneurysm was successful.     

A posteroseptal accessory pathway located in a coronary sinus aneurysm: diagnosis and radiofrequency catheter ablation.

A coronary sinus aneurysm was diagnosed by means of echocardiography, coronary sinus contrast angiography, coronary angiography, and nuclear magnetic resonance imaging in a patient with Wolff-Parkinson-White syndrome caused by a posteroseptal accessory pathway. Percutaneous radiofrequency current catheter ablation performed in the isthmus of the coronary sinus aneurysm was successful.     

射频消融位于冠状静脉窦憩室处的后间隔房室旁路

目的报道５例冠状静脉窦憩室处后间隔房室旁路的射频消融结果。方法对５例后间隔显性房室旁路患者进行电生理检查和射频消融术。术后冠状动脉造影,以观察冠状静脉窦形态。结果所有患者的冠状静脉窦近端有一憩室,并在憩室的颈部消融阻断房室旁路。成功靶点图：心室激动较体表心电图Δ波提前（３１±３．７）ｍｓ,其中４例患者伴有旁路电位。结论冠状静脉窦憩室与后间隔旁路存在着解剖关系。术中冠状静脉窦造影检查有助于发现憩室和确定有效的消融部位。     

经冠状窦消融后间隔房室旁路

８２例后间隔房室旁路的射频消融术中，５例在常规左后和右后间隔部位消融失败后，经冠状窦消融成功。５例均为预激综合征。体表心电图Ⅱ、Ⅲ、ａＶＦ导联Δ波向下，心室波呈ＱＳ型；Ｖ１导联Δ波４例向上，１例向下，心室波呈Ｒ、ｒＳ或ＱＳ型。除放电中均出现一过性胸痛、１例伴窦性心动过缓外，无其他严重并发症。     

Transvenous catheter ablation of a posteroseptal accessory pathway in a patient with coexistent posteroseptal and right-sided accessory pathways

Transvenous catheter ablation techniques have recently been used successfully in blocking posteroseptal accessory pathways in patients with Wolff-Parkinson-White syndrome (WPWS). We report the case of a patient in the People's Republic of China who had WPWS and posteroseptal and right anterolateral accessory pathways, and who had failed to respond to conventional antiarrhythmic drug therapy. The posteroseptal accessory pathway was ablated successfully. During 23 months of follow-up there were no complications; this led us to conclude that this technique can be used to achieve successful long-term ablation of this accessory pathway. This technique obviates the need for drug therapy and direct surgical ablation; it offers, as well, the advantages of shorter hospitalization, lower cost, a much shorter convalescence, and less discomfort to the patient.     

Successful catheter ablation by radiofrequency energy of posteroseptal accessory pathway in a patient with drug refractory Wolff--Parkinson--White syndrome

A 45-year-old patient with the Wolff-Parkinson-White syndromesuffering from recurrent intractable reciprocating atrioventriculartachycardia (RAVT) is reported. He used amiodarone, sotalol,quinidine, propafenone and flecainide unsuccessfully. An electrophysiological study (EPS) performed with four catheterslocalized the site of the anomalous pathway in the ostium ofthe coronary sinus. In this region we could also record a Kentpotential. In the ostium of the coronary sinus, radiofrequencv energy wasrepeatedly applied until the conduction over the accessory pathwaywas abolished both in the anterograde and the retrograde direction.The Kent deflection detectable before ablation, could not bedetected after it. During follow-up (1 month) the patient remainedasymptomatic and the control EPS showed no evidence of pre-excitation,either anterogradely or retrogradely.     

Successful catheter ablation by radiofrequency energy of posteroseptal accessory pathway in a patient with drug refractory Wolff--Parkinson--White syndrome

A 45-year-old patient with the Wolff-Parkinson-White syndromesuffering from recurrent intractable reciprocating atrioventriculartachycardia (RAVT) is reported. He used amiodarone, sotalol,quinidine, propafenone and flecainide unsuccessfully. An electrophysiological study (EPS) performed with four catheterslocalized the site of the anomalous pathway in the ostium ofthe coronary sinus. In this region we could also record a Kentpotential. In the ostium of the coronary sinus, radiofrequencv energy wasrepeatedly applied until the conduction over the accessory pathwaywas abolished both in the anterograde and the retrograde direction.The Kent deflection detectable before ablation, could not bedetected after it. During follow-up (1 month) the patient remainedasymptomatic and the control EPS showed no evidence of pre-excitation,either anterogradely or retrogradely.     

Ectopic atrial tachycardia after transvenous catheter ablation of a posteroseptal accessory pathway

Closed chest electrode catheter ablation of a posteroseptal accessory pathway was performed on an 18 year old patient with recurrent supraventricular tachycardia. After the procedure, ectopic atrial tachycardia was observed for the first time. Detailed endocardial atrial mapping revealed that this ectopic atrial tachycardia originated from the first site of catheter ablation. As retrograde conduction resumed, a second ablation procedure was performed, resulting in successful ablation of both the ectopic atrial tachycardia and the accessory pathway conduction.     

Successful catheter ablation by radiofrequency energy of posteroseptal accessory pathway in a patient with drug refractory Wolff-Parkinson-White syndrome.

A 45-year-old patient with the Wolff-Parkinson-White syndrome suffering from recurrent intractable reciprocating atrioventricular tachycardia (RAVT) is reported. He used amiodarone, sotalol, quinidine, propafenone and flecainide unsuccessfully. An electrophysiological study (EPS) performed with four catheters localized the site of the anomalous pathway in the ostium of the coronary sinus. In this region we could also record a Kent potential. In the ostium of the coronary sinus, radiofrequency energy was repeatedly applied until the conduction over the accessory pathway was abolished both in the anterograde and the retrograde direction. The Kent deflection detectable before ablation, could not be detected after it. During follow-up (1 month) the patient remained asymptomatic and the control EPS showed no evidence of pre-excitation, either anterogradely or retrogradely.     

Electroanatomical mapping and radiofrequency ablation of an accessory pathway associated with a large aneurysm of the coronary sinus.

We report a case of a patient with a left posteroseptal accessory pathway associated with a coronary sinus (CS) aneurysm. The patient had undergone two previous failed ablation attempts at other institutions despite multiple radiofrequency applications delivered within and outside the CS aneurysm. Electroanatomical mapping was performed and allowed delineation of the three-dimensional anatomy of the aneurysm, so as to identify the ventricular insertion site, and to permit successful ablation of the pathway without any complications.     

Acute coronary occlusion secondary to radiofrequency catheter ablation of a left lateral accessory pathway

A case of asymptomatic acute coronary occlusion secondary toradiofrequency catheter ablation of a left lateral accessorypathway is reported. Due to post-procedural ST modificationsof the surface ECG, a coronary angiography was performed whichdisclosed total occlusion of the first marginal branch of theleft circumflex coronary artery. A cute myocardial infarctionwas confirmed by moderate cardiac enzyme release, abnormal myocardialperfusion scan and mild lateral hypokinesia at echocardiographv.This rare but potentially harmful complication of interventionalelectrophysiology should be kept in mind and coronary angiographyperformed immediately when coronary occlusion related to radiofrequencyapplication is suspected.     

Bipolar ablation of epicardial posteroseptal accessory pathway

We present a case of a 16‐year‐old male with WPW syndrome, referred for ablation after being resuscitated from cardiac arrest. Bipolar transseptal RF ablation successfully destroyed rapidly conducting epicardial posteroseptal accessory pathway after three failed attempts of endo‐ and epicardial ablation.     

Radiofrequency catheter ablation of a concealed atrioventricular accessory pathway associated with a coronary sinus diverticulum

A 31-year-old woman underwent radiofrequency catheter ablation of a concealed left posteroseptal accessory pathway associated with a coronary sinus diverticulum. The patient had previously undergone unsuccessful catheter ablation of the posteroseptal region of the mitral annulus. Coronary sinus venography revealed the presence of the diverticulum near the ostium. An electrogram in the neck of the diverticulum showed the shortest ventriculoatrial conduction time and a large accessory pathway potential during atrioventricular reciprocating tachycardia. The pathway was successfully ablated within the neck of the diverticulum. The findings in this case underscore the importance of coronary sinus venography before ablation.     

右侧房室旁道导管射频消融治疗的体会

采用导管射频消融术（ＲＦＣＡ）阻断右侧房室旁道治疗房室折返性心动过速５０例，其中单旁道４５例，双旁道４例，三旁道１例，共５６条旁道。首次消融成功率９４％，二次消融成功率１００％。平均随访９个月，３例复发（６％），均经再次消融成功，其余病例未服用任何抗心律失常药物无心动过速复发，术后除１例右后间隔旁道消融后出现一过性Ⅲ°房室传导阻滞外无其它并发症发生。就右侧旁道消融的体会进行了讨论。     

射频导管消融左侧隐匿性房室旁路后裂隙现象:复发的表现之一

患者女性，43岁，6个月前因反复发牛心动过速，在本院接受电生理检查诊断为左侧隐匿性房室旁路，成功地进行了射频导管消融治疗，术后电生理检查以各种心房、心室起博和程序刺激方法证实心动过速不能被诱发。术后3个月，患者又发作类似于术前的心悸，发作时心率为160次／min以上，突发突止，临床考虑为室上性心动过速复发，再次入院接受电生理检查。