Successful ablation of a left-sided pathway in patient with a left atrial coronary sinus orifice : a case report (original) (raw)
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Pace-pacing and Clinical Electrophysiology, 1993
Four patients with left-sided accessory pathways (APs)and unusual coronary sinus (CS)received radiofrequency ablation. Unusual CS included occlusion of CS (patient 1), acute anguJation of proximal CS (patients 2 and 3), and narrowing of CS orifice and proximal segment (patient 4). CS catheterization and AP mapping along the CS could not be performed in the four patients. Radiofrequency ablation by left ventricular retrograde technique for the manifest left posteroseptal AP (patient 1), concealed left posterior AP (patient 2), and transseptai left atrial technique for the manifest left posteroseptal AP (patient 3)and manifest left posterior AP (patient 4)were performed successfully without CS catheter guidance. This study suggests that radiofrequency ablation of left-sided AP with unusual CS is feasible by some special techniques.
Indian heart journal
Coronary sinus electrograms generally represent the sequence of left atrial activation, and are very helpful in localizing and differentiating left lateral accessory pathway-mediated tachycardia from other supraventricular tachycardias. The activation of the coronary sinus from the left atrium occurs through muscle bridges, which may be discrete or form an intermingled continuum. These muscle bridges, if disconnected, may dissociate the coronary sinus from the left atrium, in which case the coronary sinus electrograms do not represent left atrial activation, and do not help to understand, or may cause misinterpretation of, the mechanism of supraventricular tachycardia. We report one such case of orthodromic supraventricular tachycardia mediated through the left lateral accessory pathway in which the coronary sinus got dissociated from the left atrium during radiofrequency ablation.
Cardiovascular ultrasound, 2004
Intracardiac echocardiography (ICE) is a useful tool for guiding transseptal puncture during electrophysiological mapping and ablation procedures. Left-sided accessory pathways (LSAP) can be ablated by using two different modalities: retrograde approach through the aortic valve and transseptal approach with puncture of the fossa ovalis. We shall report two cases of LSAP where transcatheter radiofrequency ablation (TCRFA) was firstly attempted via transaortic approach with ineffective results. Subsequently, a transseptal approach under ICE guidance has been performed. During atrial septal puncture ICE was able to locate the needle tip position precisely and provided a clear visualization of the "tenting effect" on the fossa ovalis. ICE allowed a better mapping of the mitral ring and a more effective catheter ablation manipulation and tip contact which resulted in a persistent and complete ablation of the accessory pathway with a shorter time of fluoroscopic exposure. ICE-gu...
Pacing and Clinical Electrophysiology, 2009
We report the case of a patient presenting with incessant monomorphic ventricular tachycardia resistant to antiarrhythmic drugs, and in whom usual percutaneous vascular or pericardial access to the left ventricle was hindered by mechanical aortic and mitral prosthetic valves. Because an epicardial location was suspected by electrocardiogram features and because access to the target area through the coronary sinus was not possible, we decided to perform a surgically based radiofrequency (RF) ablation. Catheter mapping of the epicardial surface through surgical left lateral thoracotomy in the operating room confirmed the epicardial location of the arrhythmogenic substrate and allowed successful RF ablation of the clinically incessant tachycardia. Combined surgical and electrophysiological approach should therefore be performed when RF ablation is needed in case of unadvisable, difficult, or failed nonsurgical percutaneous access. (PACE 2009; 32:556-560)
Catheter Ablation of Left Parietal Accessory Pathways
Journal of Interventional Cardiology, 1990
Fifty‐one patients with a left parietal pathway and drug refractory tachycardia underwent transcatheler ablation of their accessory pathway. Three had single concealed pathways, two had multiple pathways, and the remaining 46 had the Wolff‐Parkinson‐While syndrome. Two patients were resuscitated from a cardiac arrest related to a ventricular fibrillation. A multipolar (quadri‐, hexa‐, or octopolar) electrode catheter was positioned within the coronary sinus in order to localize the pathway accurately. An ablation catheter was then introduced either through a patent foramen ovale (11 patients), by transseptal catheterization (14 patients) or a retrograde arterial catheterization (26 patients). The mitral annulus was mapped with this catheter during orthodromic tachycardia in order to record ventriculoatrial (VA) time as short as (or even shorter than) that recorded in the coronary sinus. The VA time in our series was 82 ± 13 msec. Two 160‐joule cathodal shocks were delivered at this ...