title: Radiofrequency ablation of posteroseptal accessory pathways associated with coronary sinus diverticula.
abstract: OBJECTIVE
  Posteroseptal accessory pathways may be associated with a coronary sinus (CS) diverticulum. Our purpose was to describe the clinical characteristics, mapping and ablation of these pathways.
  
  
  METHODS
  This was a retrospective study of all patients who underwent ablation of posteroseptal accessory pathways in a single centre. Patients with a diverticulum of the CS or one of its tributaries were included in group I, while the other patients formed group II. Clinical presentation, ablation procedure and outcome were compared between the two groups.
  
  
  RESULTS
  A total of 51 patients were included, 16 in group I and 35 in group II. There were no significant differences in age or sex distribution. Atrial fibrillation (AF) and previous unsuccessful ablation were more common in group I. A negative delta wave in lead II was the ECG finding with best sensitivity and specificity for the presence of a diverticulum. A pathway potential was common at the successful site in group I, and the interval between local ventricular electrogram and delta wave onset was shorter (19.5 ± 8 vs 33.1 ± 7.6 ms, p < 0.001). There was a trend toward lower procedural success rate and higher recurrence rate in group I, although this was not significant.
  
  
  CONCLUSIONS
  CS diverticula should be suspected in patients with manifest posteroseptal accessory pathways who have a previous failed ablation, documented AF or typical electrocardiographic signs. A discrete potential is frequently seen at the successful site, but the local ventricular electrogram is not as early as in other accessory pathways.
authors: Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India. rajajs@gmail.com.
authors: Raja J
authors: RJ
authors: Selvaraj
authors: Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
authors: Krishna
authors: K
authors: Sarin
authors: Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
authors: Vivek Raj
authors: VR
authors: Singh
authors: Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
authors: Santhosh
authors: S
authors: Satheesh
authors: Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
authors: Ajith Ananthakrishna
authors: AA
authors: Pillai
authors: Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
authors: Mahesh
authors: M
authors: Kumar
authors: Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
authors: Jayaraman
authors: J
authors: Balachander
mesh_terms: D058606:Accessory Atrioventricular Bundle / Q000175:diagnosis* / Q000601:surgery*; D000328:Adult; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D004240:Diverticulum / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006343:Heart Septal Defects / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Ablation; Coronary sinus; Diverticulum; Posteroseptal; WPW