Radiofrequency Ablation of Left‐Sided Accessory Atrioventricular Pathways in Patients with Unusual Coronary Sinus

Abstract

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 angulation 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 transseptal 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.

A Unipolar Coronary Sinus Mapping Study of Patients with Left-Sided Atrioventricular Accessory Pathways

“…A routine coronary angiogram was performed in each patient prior to placement of the electrode catheters. The coronary venous phase was restored and carefully observed to examine the CS anomalies sometimes associated with WPW syndrome, 9,10) and to delineate the gross CS anatomy. Thereafter, a fine 16-polared 11,12) For patients with a left-sided atrioventricular accessory pathway, an ablation catheter was inserted from the right femoral artery, retrogradely advanced, and then fixed at the mitral subannular position within the left ventricle.…”