Supraventricular tachycardia in patients with coronary sinus stenosis/atresia: Prevalence, anatomical features, and ablation outcomes

Abstract

Background: Supraventricular tachycardia (SVT) with coronary sinus (CS) ostial atresia (CSA) or coronary sinus stenosis (CSS) causes difficulty in electrophysiological procedures, but its characteristics are poorly understood. Objective: Study the anatomical and clinical features of SVT patients with CSA/CSS. Methods: Of 6128 patients with SVT undergoing electrophysiological procedures, consecutive patients with CSA/CSS were enrolled, and the baseline characteristics, imaging materials, intraoperative data, and follow-up outcomes were analyzed. Results: Thirteen patients, seven with CSA and six with CSS, underwent the electrophysiological procedure. Decapolar catheters were placed into the proximal CS in three cases, while the rest were placed at the free wall of the right atrium. Fourteen arrhythmias were confirmed: four atrioventricular nodal reentrant tachycardias, five left-sided accessory pathways, three paroxysmal atrial fibrillations, and two atrial flutters (AFLs). In addition to three patients who underwent only an electrophysiological study, the acute ablation success rate was 100% in 10 cases, with no procedure-related complications. After a median follow-up period of 59.6 months, only one case of atypical AFL recurred. For those cases (seven CSA and two CSS) with a total of 10 anomalous types of CS drainage, three types were classified: from the CS to the persistent left superior vena cava (n = 3), from an unroofed CS (n = 3), and from the CS to the small cardiac vein (n = 3) or Thebesian vein (n = 1). Conclusion: Patients with CSA/CSS may develop different kinds of SVT. Electrophysiological procedures for such patients are feasible and effective. An individualized mapping strategy based on the three types of CS drainage will be helpful.

Concomitant Coronary Artery Disease and Persistent Left Superior Vena Cava in a Patient Presenting With Symptomatic Sinus Bradycardia: A Case Report

“…PLSVC is an uncommon congenital anomaly with various consequences for patients. PLSVC is known to be associated with complete heart block and pacemaker implantation in patients [ 5 ]. The existence of PLSVC has also been reported with coronary artery disease, although no causal link has been found [ 6 ].…”

“…In patients requiring PPM, a PLSVC can lead to many complications. The methods used to overcome this setback include a hybrid approach with epicardial lead pacing, bi-atrial pacing, dual-chamber rate-adaptive pacemaker pacing with contralateral lead placement, or the typical RV lead placement, which was used in our case as well [ 5 ]. PLSVC increases the risk of sudden cardiac death, and the patient might be considered for corrective surgery [ 8 ].…”

“…PLSVC has been implicated in rhythm disorders and abnormal electrical axis. The electrical instability usually manifests as supraventricular arrhythmia with AV-nodal reentrant tachycardia (AVNRT) being the most common subtype [ 5 ]. This is the first-ever case report of PLSVC from South Asia, presenting with severe symptomatic sinus bradycardia and requiring a permanent pacemaker (PPM).…”

Coronary sinus Ostial atresia with a window to the left atrium and persistent left superior vena cava in an adult patient

“…Type (C): Anomalous CS drainage (asterisk) into the RA through an accessory vein, such as a small cardiac vein or a Thebesian vein. 2 This case belongs to the type B. A PLSVC results from persistent patency of the left anterior cardinal vein draining into a dilated coronary sinus.…”