Simultaneous epicardial and endocardial mapping of a left-sided posteroseptal accessory pathway associated with a large coronary sinus diverticulum: successful ablation by transection of the diverticulum's neck.
Transcutaneous pericardial instrumentation in a patient with a left-sided posteroseptal accessory pathway associated with a large coronary sinus diverticulum was performed after three previous unsuccessful ablations. The earliest ventricular activation site was recorded epicardially using a catheterin the pericardial space, but energy delivery at this site was not possible due to high impedances. Intravascular linear lesions transecting the neck of the large coronary sinus diverticulum using the pericardial catheter as a target allowed successful radiofrequency catheter ablation of the accessory pathway. This case outlines potential problems with ablations in the pericardial space and provides an alternative solution that can spare patients from open surgical procedures.
Saad
Eduardo B
EB
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Ohio 44195, USA.
Marrouche
Nassir F
NF
Cole
Christopher R
CR
Natale
Andrea
A
D017115:Catheter Ablation / Q000379:methods*; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D004240:Diverticulum / Q000150:complications*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D015641:Radiography, Interventional; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications / Q000473:pathology / Q000601:surgery*